(2022) CPT Code 93241 Description, Guidelines, Reimbursement, Modifiers & Example

CPT code 93241 (2022) maintained by the American Medical Association, is a medical procedure code for external electrocardiographic recording under the range of Cardiovascular Monitoring Services.

CPT Code 93241 Description

A long-term electrocardiographic (ECG) monitoring is a diagnostic procedure that records the patient’s heart rhythm during regular daily activities, including sleep, while wearing an external ECG recording device.

The prevalence of a clinically significant rhythm disturbance and a waveform abnormality may frequently determine and identify its existence by this procedure that is missed on a standard electrocardiogram. This procedural service is suitable when heart arrhythmias are known or suspected to occur at least once in 48 hours.

The external recording device may typically include both the recording device and electrode in a compact, single, lightweight, waterproof unit that is worn continuously for 21 days. 

In this procedure, the provider applies an electrocardiographic recorder on the upper aspect of the left chest to aid in the detection of any abnormal heart rates and rhythm of the patient. The provider will test the device, obtain an initial recording, and provide instruction on the use and care of the recording device to the patient.

The provider will then activate the device, and the ECG rhythm is recorded and stored for more than 48 hours up to 7 days continuously. The patient returns the recording device to the physician’s office after the prescribed time has elapsed. 

The service performed includes recording, scanning, analyzing, compiling, and interpreting the electrocardiographic findings performed by the physician or other qualified healthcare professional for a complete procedure that comprises the rhythm recording and its storage, scanning analysis with report, and the review and interpretation by the physician or other qualified health care professional, report CPT code 93241.

Suppose the physician or other qualified healthcare professional performs the recording only that comprises the connection and initial trial recording, report CPT code 93242. When the scanning analysis and reported only by a physician or other qualified health care professional, report CPT code 93243.

If the physician or other qualified health care professional performs the ECG recording review and interpretation only, report CPT code 93244.

CPT Code 93241 Reimbursement

A maximum of one unit of CPT code 93241 can be billed on the same service data by the same provider or other qualified health care professional performed on the same patient.

The Relative Value Unit (RVUs) and fees for non-facility settings for this procedure are priced per individual carrier. This means that Carriers will establish RVUs, and fees amount for this service which is generally on a case-to-case basis following a review of the provider’s documentation in the operative report.

According to the Medicare Physician Fee Schedule, CPT code 93241 is a global test-only code. This means that this code identifies as a standalone diagnostic test code.

Therefore, associated codes already describe the professional and technical components of the test performed, and modifiers 26 and TC should not be used with this code.

Furthermore, this code’s total RVU as a global procedure only code includes the values for physician work, the practice expense, and the malpractice expense is equal to the sum of the total RVUs for the professional and technical components only codes that are being combined.

CPT Code 93241 Modifiers

The following is the list of modifiers applicable with CPT code 93241:

Modifiers 22, 23, 47, 51, 52, 53, 58, 59, 76, 77, 78, 79, 99, AI, AQ, AR, CC, CR, ET, EY, GA, GC, GK, GR, GU, GZ, KX, Q5, Q6, QJ, SG, TC, XE, XP, XU, XS.

Below will provides some of the modifier usages for this code in greater instruction.

Modifier 22, defined by CPT as increased procedural services, applies to CPT code 93241 when the service performed is longer than usual or takes additional resources during the performance of the procedure.

Modifier 23, defined by CPT as unusual anesthesia, applies to CPT code 93241 when general anesthesia or local anesthesia administers by the physician or other qualified health care professional and routinely does not require it during the performance of the procedure.

Modifier 52, defined by CPT as reduced services, applies to CPT code 93241 when the cardiovascular monitoring service hours and service discontinue due to unavoidable circumstances or if the provider plans or expects a reduction in the service or electively cancels the performance of the procedure before its completion.

Modifier 53, defined by CPT as a discontinued procedure, applies to CPT code 93241 if a provider or other qualified healthcare professional discontinues a procedure due the patient risk or if the provider or other qualified healthcare professional must stop the performance of the procedure due to equipment failure or other extenuating circumstances.

Modifier 59, defined by CPT as a distinct procedural service, applies to CPT code 93241 when the service performed is bundled with another procedure or service by the same provider or other qualified health care professional on the same date of service.

The modifier X (E, P, S, U) is reported instead of modifier 59 with CPT code 93241 when the procedure or service is being reimbursed to Medicare carriers. The modifier X (E, P, S, U) is a subset of modifier 59 that provides a further distinct specification of the procedure or service.

Modifier 76, defined by CPT as a repeat procedure or service by the same physician or other qualified healthcare professional, applies to CPT code 93241 when a service or procedure performed by the same physician or other qualified healthcare professionals on the same date of service is identical to the original service or procedure performed.

Modifier GA, defined by CPT as a waiver of liability statement issued by payer policy as required on an individual case, applies to CPT code 93241 when the physician or other qualified health care professional believes that Medicare will deny such service or procedure.

The beneficiary must sign an Advance Beneficiary Notification (ABN) before providing the service or procedure and apply the GA modifier to the service or procedure performed.

CPT Code 93241 Billing and Coding Guidelines

It may be considered medically necessary when using auto-activated external electrocardiographic event recordings in the outpatient setting and are non-covered for inpatient or outpatient observation care. Therefore, medical record documentation that supports medical necessity may be requested.

The following list of ICD 10 CM can support reporting of the CPT code 93241:

G45.0, G45.1, G45.2, G45.3, G45.4, G45.8, G45.9, I20.0, I20.1, I20.8, I21.01, I21.02, I21.09, I21.11, I21.19, I21.21, I21.29, I21.4, I21.9, I21.A1, I21.A9, I22.0, I22.1, I22.2, I22.8, I24.0, I24.1, I24.8, I25.110, I25.111, I25.118, I25.2, I25.700, I25.701, I25.708, I25.710, I25.711, I25.718, I25.720, I25.721, I25.728, I25.730, I25.731, I25.738, I25.750, I25.751, I25.758, I25.760, I25.761, I25.768, I25.790, I25.791, I25.798, I44.0, I44.1, I44.2, I44.39, I44.4, I44.5, I44.69, I44.7, I45.0, I45.19, I45.2, I45.3, I45.4, I45.5, I45.6, I45.81, I45.89, I47.0, I47.1, I47.2, I47.9, I48.0, I48.11, I48.19, I48.20, I48.21, I48.3, I48.4, I48.91, I48.92, I49.01, I49.02, I49.1, I49.2, I49.3, I49.5, I49.8, I63.10, I63.111, I63.112, I63.113, I63.119, I63.12, I63.131, I63.132, I63.133, I63.139, I63.19, I63.40, I63.411, I63.412, I63.413, I63.419, I63.421, I63.422, I63.423, I63.429, I63.431, I63.432, I63.433, I63.439, I63.441, I63.442, I63.443, I63.449, I63.49, R00.1, R00.2, R06.01, R06.02, R06.03, R06.09, R06.2, R06.3, R06.4, R06.81, R06.82, R06.83, R06.89, R07.2, R07.82, R07.89, R07.9, R29.5, R40.4, R42, R55, Z79.891, Z79.899. Z86.73.

Documentation in the medical record supporting the medical necessity is crucial for proper reimbursement using the external electrocardiographic event recording. The following recommended documentation components are best practices to support the claim that is being submitted:

Beneficiary’s relevant signs and symptoms and medically appropriate history

The frequency of signs and symptoms occurrence

Any prior test results, if applicable.

The rationale for the need for continuous electrocardiographic monitoring for greater than 48 hours up to 7 days

Expectations on improved diagnostic implications and the beneficiary’s compliance using the extended electrocardiographic event monitoring.

Additional documentation requirements include and are not limited to the following:

All documentation must be maintained in the beneficiary’s clinical record and made available upon request.

Every page of the clinical record must be legible and include appropriate beneficiary identification information.

The medical record must include a legible signature of the physician or other qualified health care professional responsible for and providing care to the beneficiary.

The reported medical documentation must support the use of the selected ICD-10-CM code(s) and must describe the service being performed for the reported CPT/HCPCS code.

93241 CPT Code Clinical Example

A female patient presented to the physician’s office for weakness and tingling in the upper extremity. The patient denies any other condition during the review of the system.

Physical examination revealed that the patient had heart irregularities, edema, and shortness of breath. The patient physical examination suggests ruling out the heart-related arrhythmias.

The physician performs an EKG to determine and identify any existing waveform abnormality. Diagnostic studies show that the patient may have heart arrhythmias and suggest extended electrocardiographic monitoring for greater than 48 hours and up to 7 days.

In addition, the physician has ordered a consultation with a cardiologist for further work-up.

Timmy Castillejos
– CPC, CPMA, CCVTC, CPC-I, CCS, CLSSGB, LFC, AAPC Approved-Instructor