Local Coverage Determination (LCD)

Electrocardiograms

L34315

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Proposed LCD
Proposed LCDs are works in progress that are available on the Medicare Coverage Database site for public review. Proposed LCDs are not necessarily a reflection of the current policies or practices of the contractor.

Document Note

Note History

Contractor Information

LCD Information

Document Information

Source LCD ID
N/A
LCD ID
L34315
Original ICD-9 LCD ID
Not Applicable
LCD Title
Electrocardiograms
Proposed LCD in Comment Period
N/A
Source Proposed LCD
DL34315
Original Effective Date
For services performed on or after 10/01/2015
Revision Effective Date
For services performed on or after 10/01/2019
Revision Ending Date
N/A
Retirement Date
N/A
Notice Period Start Date
02/07/2018
Notice Period End Date
03/25/2018

CPT codes, descriptions, and other data only are copyright 2023 American Medical Association. All Rights Reserved. Applicable FARS/HHSARS apply.

Fee schedules, relative value units, conversion factors and/or related components are not assigned by the AMA, are not part of CPT, and the AMA is not recommending their use. The AMA does not directly or indirectly practice medicine or dispense medical services. The AMA assumes no liability for data contained or not contained herein.

Current Dental Terminology © 2023 American Dental Association. All rights reserved.

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Making copies or utilizing the content of the UB‐04 Manual, including the codes and/or descriptions, for internal purposes, resale and/or to be used in any product or publication; creating any modified or derivative work of the UB‐04 Manual and/or codes and descriptions; and/or making any commercial use of UB‐04 Manual or any portion thereof, including the codes and/or descriptions, is only authorized with an express license from the American Hospital Association. The American Hospital Association (the "AHA") has not reviewed, and is not responsible for, the completeness or accuracy of any information contained in this material, nor was the AHA or any of its affiliates, involved in the preparation of this material, or the analysis of information provided in the material. The views and/or positions presented in the material do not necessarily represent the views of the AHA. CMS and its products and services are not endorsed by the AHA or any of its affiliates.

Issue

Issue Description
Issue - Explanation of Change Between Proposed LCD and Final LCD

CMS National Coverage Policy

Title XVIII of the Social Security Act (SSA), §1862(a)(1)(A), states that no Medicare payment shall be made for items or services that "are not reasonable and necessary for the diagnosis or treatment of illness or injury or to improve the functioning of a malformed body member."

Title XVIII of the Social Security Act, §1862(a)(7) and 42 Code of Federal Regulations, §411.15, exclude routine physical examinations.

Title XVIII of the Social Security Act, §1833(e), prohibits Medicare payment for any claim lacking the necessary documentation to process the claim.

Medicare's Carrier's Manual (MCM), §15047(D), explains coverage for preoperative diagnostic tests performed to determine a patient's perioperative risks and optimize perioperative care. (The reference will be crosswalked to the CMS Manual System, Publication 100-04, Medicare Claims Processing Manual, Chapter 12, §30.6.6.1 as soon as it become available.)

Medicare Carriers Manual, §15047(G), explains how to report preoperative tests. (The reference will be crosswalked to the CMS Manual System, Publication 100-04, Medicare Claims Processing Manual, Chapter 12, §30.6.6.1 as soon as it becomes available.)

CMS Manual System, Publication 100-04, Medicare Claims Processing Manual, Chapter 12, §20.3(E), describes bundling of payment for ECG services supplied concomitantly with other physician services.

CMS Manual System, Publication 100-04, Medicare Claims Processing Manual, Chapter 13, §100.1, states that in general only one payment is made for one interpretation of an EKG.

CMS Manual System, Publication 100-04, Medicare Claims Processing Manual, Chapter 23, §20.9.1. Correct Coding Initiative (CCI) describes correct usage of the 59 modifier for repeat procedural services performed on the same day.

CMS Manual System, Publication 100-03, Medicare National Coverage Determinations Manual, Chapter 1, §20.15, Electrocardiogram Service, "No payment is made for EKG interpretations by individuals other than physicians' and "A separate charge by an attending or consulting physician for EKG interpretation is allowed only when it is the normal practice to make such charge".

CMS Manual System, Publication 100-02, Medicare Benefit Policy Manual, Chapter 15, §§190 and 200, allow for services supplied by physician assistants and nurse practitioners.

CMS Manual System, Publication 100-02, Medicare Benefit Policy Manual, Chapter 15, §250, states that payment may be made under Part B for the medical and other health services enumerated in paragraph C, but only where no payment can be made for such services under Part A.

Coverage Guidance

Coverage Indications, Limitations, and/or Medical Necessity

The electrocardiogram (ECG, EKG) and ECG rhythm strip records the electrical activity of the heart throughout the cardiac cycle of contraction (depolarization) and relaxation (repolarization). The changes in electrical potential during the cardiac cycle are detected at the body surface and recorded on graph paper. The recording is reviewed by a physician who provides an interpretation and written report. An ECG may be reported as the technical aspect only, the interpretation and written report only, or both aspects together as one service.

The electrical activity of the heart can be viewed along various electrical axes (viewpoints). Each viewpoint is described as a "lead”. A typical ECG views the heart from 12 axes and, therefore, has 12 leads. A rhythm strip typically includes one to three leads. Typically, a 12-lead ECG is a separate document from the medical progress notes, while a printed rhythm strip may be pasted into the progress notes.

An ECG is indicated to diagnose or treat a patient for symptoms, signs, or a history of heart disease; or systemic conditions that affect the heart, including:

  • Chest pain or angina pectoris,
  • Myocardial ischemia or infarction,
  • Arteriovascular disease including coronary, central, and peripheral disease,
  • Hypertension,
  • Conduction abnormalities,
  • Cardiac rhythm disturbances,
  • Cardiac hypertrophy,
  • Heart failure,
  • Pericarditis,
  • Structural cardiac conditions,
  • Endocrine abnormalities,
  • Neurological disorders affecting the heart,
  • Syncope,
  • Paroxysmal weakness,
  • Palpitations,
  • Sudden lightheadedness,
  • Electrolyte imbalance,
  • Acid-base disorders,
  • Temperature disorders,
  • Pulmonary disorders, and
  • Drug cardiotoxicity.


An ECG may help identify cardiac disorders as part of a preoperative clinical evaluation. A preoperative ECG may be reasonable and necessary under one of the following conditions:

  • In the presence of pre-existing heart disease such as congestive heart failure, prior myocardial infarction (MI), angina, coronary artery disease, or dysrhythmias;
  • In the presence of known comorbid conditions that may affect the heart, such as chronic pulmonary disease, peripheral vascular disease, diabetes, or renal impairment; or
  • When the pending surgery requires a general or regional anesthetic.
Summary of Evidence

NA

Analysis of Evidence (Rationale for Determination)

NA

Proposed Process Information

Synopsis of Changes
Changes Fields Changed
N/A
Associated Information
Sources of Information
Bibliography
Open Meetings
Meeting Date Meeting States Meeting Information
N/A
Contractor Advisory Committee (CAC) Meetings
Meeting Date Meeting States Meeting Information
N/A
MAC Meeting Information URLs
N/A
Proposed LCD Posting Date
Comment Period Start Date
Comment Period End Date
Reason for Proposed LCD
Requestor Information
This request was MAC initiated.
Requestor Name Requestor Letter
View Letter
N/A
Contact for Comments on Proposed LCD

Coding Information

Bill Type Codes

Code Description

Please accept the License to see the codes.

N/A

Revenue Codes

Code Description

Please accept the License to see the codes.

N/A

CPT/HCPCS Codes

Please accept the License to see the codes.

N/A

ICD-10-CM Codes that Support Medical Necessity

Group 1

Group 1 Paragraph:

N/A

Group 1 Codes:

N/A

N/A

ICD-10-CM Codes that DO NOT Support Medical Necessity

Group 1

Group 1 Paragraph:

N/A

Group 1 Codes:

N/A

N/A

Additional ICD-10 Information

General Information

Associated Information

No comments were received for this draft LCD for comment period ending 08/14/2017.

Sources of Information
  1. Other contractor’s local medical review policies
  2. Contractor Medical Director
  3. New England and Los Angeles LMRPs
Bibliography

NA

Revision History Information

Revision History Date Revision History Number Revision History Explanation Reasons for Change
10/01/2019 R11

The LCD is revised to remove CPT/HCPCS codes in the Keyword Section of the LCD.

At this time 21st Century Cures Act will apply to new and revised LCDs that restrict coverage which requires comment and notice. This revision is not a restriction to the coverage determination; and, therefore not all the fields included on the LCD are applicable as noted in this policy.

  • Other (The LCD is revised to remove CPT/HCPCS codes in the Keyword Section of the LCD.)
10/01/2019 R10

As required by CR 10901, all billing and coding information has been moved to the companion article, this article is linked to the LCD.

10/1/2019: At this time 21st Century Cures Act will apply to new and revised LCDs that restrict coverage which requires comment and notice. This revision is not a restriction to the coverage determination; and, therefore not all the fields included on the LCD are applicable as noted in this policy.

  • Revisions Due To Code Removal
10/01/2019 R9

Effective 10/01/2019, the following codes were added, deleted and revised per the 2019/2020 annual ICD-10 updates.

Added to Group 1:

  • I26.93 - Single subsegmental pulmonary embolism without acute cor pulmonale
  • I26.94 - Multiple subsegmental pulmonary emboli without acute cor pulmonale
  • I48.11 - Longstanding persistent atrial fibrillation
  • I48.19 - Other persistent atrial fibrillation
  • I48.20 - Chronic atrial fibrillation, unspecified
  • I48.21 - Permanent atrial fibrillation
  • T6701XA - Heatstroke and sunstroke, initial encounter
  • T6701XD - Heatstroke and sunstroke, subsequent encounter
  • T6701XS - Heatstroke and sunstroke, sequela
  • T6702XA - Exertional heatstroke, initial encounter
  • T6702XD - Exertional heatstroke, subsequent encounter
  • T6702XS - Exertional heatstroke, sequela
  • T6709XA - Other heatstroke and sunstroke, initial encounter
  • T6709XD -Other heatstroke and sunstroke, subsequent encounter
  • T6709XS - Other heatstroke and sunstroke, sequela

Deleted from Group 1:

  • I48.1 - Persistent atrial fibrillation
  • I48.2 - Chronic atrial fibrillation
  • T67.0XXA - Heatstroke and sunstroke, initial encounter
  • T67.0XXD - Heatstroke and sunstroke, subsequent encounter
  • T67.0XXS - Heatstroke and sunstroke, sequela

Description Changes from Group1

  • Revised from J44.0 – Chronic obstructive pulmonary disease with acute lower respiratory infection to J44.0 - Chronic obstructive pulmonary disease with (acute) lower respiratory infection

09/16/2019 - At this time 21st Century Cures Act will apply to new and revised LCDs that restrict coverage which requires comment and notice. This revision is not a restriction to the coverage determination; and, therefore not all the fields included on the LCD are applicable as noted in this policy.

  • Creation of Uniform LCDs Within a MAC Jurisdiction
  • Revisions Due To ICD-10-CM Code Changes
10/01/2018 R8

09/06/2018 - At this time 21st Century Cures Act will apply to new and revised LCDs that restrict coverage which requires comment and notice. This revision is not a restriction to the coverage determination; and, therefore not all the fields included on the LCD are applicable as noted in this policy.

 

The following ICD-110 codes were added, deleted and revised per the Annual ICD-10 Updates.

Added: E78.41, E78.49, I63.81, I63.89, I67.850, I67.858, K82.A2, K83.01, T43.641A, T43.641D, T43.641S, T43.642A, T43.642D, T43.642S, T43.643A, T43.643D, T43.643S, T43.644A, T43.644D and T43.644S.

Deleted: E78.4 and I63.8.

Revised: I63.333 and T81.11XA, T81.11XD and T81.11XS.

  • Revisions Due To ICD-10-CM Code Changes
03/26/2018 R7

05/08/2018 - At this time 21st Century Cures Act will apply to new and revised LCDs that restrict coverage which requires comment and notice. This revision is not a restriction to the coverage determination; and, therefore not all the fields included on the LCD are applicable as noted in this policy.

LCD revised to add ICD-10-CM Z51.81 and Z79.899 effective 03/26/2018. There is no change in the LCD coverage.

  • Creation of Uniform LCDs Within a MAC Jurisdiction
03/26/2018 R6

01/17/18-At this time 21st Century Cures Act will apply to new and revised LCDs that restrict coverage which requires comment and notice. This revision is not a restriction to the coverage determination; and, therefore not all the fields included on the LCD are applicable as noted in this policy.

LCD revised to update the language referenced from the IOM 100-4 Chapter 13 Section 100.1 from carriers to A/B MACs (B) and add the following ICD-10 codes  new for 2018 because they are within the coverage indications of this LCD: E85.81-E85.82, E85.89, I21.9, I21.A1, I21.A9, I27.20-I27.24, I27.29, I27.83, I50.810-I50.814, I50.82-I50.84, I50.89 and R06.03,

  • Creation of Uniform LCDs Within a MAC Jurisdiction
10/01/2017 R5

08/24/2017: At this time 21st Century Cures Act will apply to new and revised LCDs that restrict coverage which requires comment and notice. This revision is not a restriction to the coverage determination; and, therefore not all the fields included on the LCD are applicable as noted in this policy.

Effective DOS 10/01/2017 the following ICD-10-CM codes were added, deleted and had a description change:

Added:

  • E85.81
  • E85.82
  • E85.89
  • I21.9
  • I21.A1
  • I21.A9
  • I27.20
  • I27.21
  • I27.22
  • I27.23
  • I27.24
  • I27.29
  • I27.83
  • I50.810
  • I50.811
  • I50.812
  • I50.813
  • I50.814
  • I50.82
  • I50.83
  • I50.84
  • I50.89
  • R06.03

 

The following ICD-10 codes were deleted from the ICD-10 Codes that Support Medical Necessity field:
E85.8 was deleted from Group 1
I27.2 was deleted from Group 1

The following ICD-10 code descriptions were changed in the ICD-10 Codes that Support Medical Necessity field:
I50.1 descriptor was changed in Group 1
I63.323 descriptor was changed in Group 1
I63.333 descriptor was changed in Group 1
I63.513 descriptor was changed in Group 1
I63.523 descriptor was changed in Group 1
I63.533 descriptor was changed in Group 1

 

  • Aberrant Local Utilization
10/01/2016 R4 The LCD is revised to add ICD-10 codes effective 10/1/2016:
E78.00, E78.01, H34.8110, H34.8111, H34.8120, H34.8121, H34.8130, H34.8131, H34.8310, H34.8311, H34.8320, H34.8321, H34.8330, H34.8331 ,I63.033, I63.113, I63.133, I63.213, I63.233, I63.313, I63.323, I63.333, I63.413, I63.423, I63.433, I63.443, I63.513, I63.523, I63.533, I63.543, I97.621, I97.622, I97.630, I97.631, I97.638, I97.640, I97.641, J98.51, J98.59, Q25.21, Q25.29, Q25.40, Q25.41, Q25.42, Q25.43, Q25.44, Q25.45, Q25.46, Q25.47, Q25.48, Q25.49.

ICD-10 codes deleted from Group 1 effective 10/1/2016:
E78.0, H34.811, H34.812, H34.813, H34.831, H34.832, H34.833, J98.5, Q25.2, Q25.4.

ICD-10 code descriptions were changed in Group 1:
I77.79, O15.02, O15.03, O15.1, O15.2, T82.817A, T82.817D, T82.817S, T82.827A, T82.827D, T82.827S, T82.837A, T82.837D, T82.837S, T82.847A, T82.847D, T82.847S, T82.857A, T82.857D, T82.857S, T82.867A, T82.867D, T82.867S.

  • Revisions Due To ICD-10-CM Code Changes
10/01/2015 R3 R3 LCD updated to add ICD-10-CM codes A17.89 A39.50 B33.20 B33.24 B39.0 B39.1 B39.2 B39.3 B39.4 B39.5 M10.9 E05.91 E85.9 E85.2 D57.819 F11.129 I01.9 I09.1 I05.9 I06.9 I08.9 I24.9 I20.9 I25.119 I25.701 I25.708 I25.709 I25.719 I25.729 I25.739 I25.759 I25.769 I25.799 I30.9 I33.9 I40.9 I44.30 I44.7 I45.9 I47.9 I49.40 I63.511 I63.512 I63.521 I63.522 I63.531 I63.532 I63.541 I63.542 I63.59 I63.9 J44.9 J45.902 K20.9 O03.81 O03.7 O14.92 O14.93 O14.10 O14.20 O88.019 O88.119 O88.319 Q21.9 Q24.9 R00.0 R56.9 R57.9 R10.9 R10.10 R68.84 G47.31 G47.32 G47.33 G47.34 G47.11 G47.12 G47.21 G47.22 G47.23 G47.24 S25.429A S25.429D S25.429S S26.00XA S26.00XD S26.00XS S26.10XA S26.10XD S26.10XS S26.90XA S26.90XD S26.90XS S26.99XA S26.99XD S26.99XS S21.301A S21.301D S21.301S S21.302A S21.302D S21.302S S21.309A S21.309D S21.309S S21.319A S21.319D S21.319S S21.329A S21.329D S21.329S S21.339A S21.339D S21.339S S21.349A S21.349D S21.349S T46.901A T46.901D T46.901S T46.902A T46.902D T46.902S T46.903A T46.903D T46.903S T46.904A T46.904D T46.904S T78.2XXA T78.2XXD T78.2XXS T78.00XA T78.00XD T78.00XS Z95.820 Z95.828 Z01.812 effective 10/1/15
  • Reconsideration Request
  • Revisions Due To ICD-10-CM Code Changes
10/01/2015 R2 R2 LCD revised to add I49.9 and R00.1
  • Reconsideration Request
10/01/2015 R1 The LCD revised to add ICD-10 code I48.91, I48.92 and R07.9 to group 1. The effective date remains 10/1/2015.
  • Reconsideration Request
N/A

Associated Documents

Attachments
N/A
Related National Coverage Documents
N/A
Public Versions
Updated On Effective Dates Status
01/27/2020 10/01/2019 - N/A Currently in Effect You are here
10/03/2019 10/01/2019 - N/A Superseded View
Some older versions have been archived. Please visit the MCD Archive Site to retrieve them.

Keywords

  • Electrocardiograms
  • ECG
  • EKG

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