CMS Electrocardiographic (EKG or ECG) Monitoring (Holter or Real-Time Monitoring) Form

Summary Of Evidence

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Analysis of Evidence

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Long-Term ECG Monitoring is defined as a diagnostic procedure, which can provide continuous recording capabilities of ECG activities of the patient's heart while the patient is engaged in daily activities. These can include continuous, patient-demand or auto-detection devices. The purpose of these tests is to provide information about rhythm disturbances and waveform abnormalities and to note the frequency of their occurrence.

Cardiac Event Detection (CED) is a 30-day service for the purpose of documentation and diagnosis of paroxysmal or suspected arrhythmias.

Holter Monitoring (24-hour ECG monitoring) is a study used to evaluate the patient's ambient heart rhythm during a full day's (24 Hours) cycle. It is a wearable EKG monitor that records the overall rhythm and significant arrhythmias.

1. Medical Necessity:
   
   The medical necessity indications listed in this policy must be present in order for these tests to be covered.
2. Indications for external 48-hour ECG recording include one or more of the following:
   1. Symptoms:
   1. Arrhythmias
   2. Chest pain
   3. Syncope (lightheadedness) or near syncope
   4. Vertigo (dizziness)
   5. Palpitations
   6. Transient ischemic episodes
   7. Dyspnea (shortness of breath)
   2. Evaluation of the response to antiarrhythmic drug therapy.
   3. Evaluation of myocardial infarction (MI) survivors with an ejection fraction of 40% or less.
   4. Assessment of patients with coronary artery disease with active symptoms, to correlate chest pain with ST-segment changes.
   5. Other acute and subacute forms of ischemic heart disease.
   6. To detect arrhythmias post ablation procedures.
3. The use of external electrocardiographic recording for greater than 48 hours and up to 7 days or for greater than 7 days up to 15 days by continuous rhythm recording and storage, may be considered medically necessary in patients treated for reasons listed in the diagnosis list to monitor for asymptomatic episodes in order to evaluate treatment response. The use of external electrocardiographic event monitors for greater than 48 hours and up to 7 days or for greater than 7 days up to 15 days that are either patient-activated or auto-activated may be considered medically necessary as a diagnostic alternative to Holter monitoring in patients who experience infrequent symptoms (less frequently than every 48 hours) suggestive of cardiac arrhythmias (i.e., palpitations, dizziness, presyncope, or syncope). (Refer to current CPT codebook)
4. Long term 30-day monitoring: Telephonic Transmission of ECG involves 24 hour attended monitoring per 30-day period of time; no other EKG monitoring codes can be billed simultaneously with these codes.
   Indications for performing a Telephonic Transmission:
   1. Arrhythmias
   2. Chest pain
   3. Syncope (lightheadedness) or near syncope
   4. Vertigo (dizziness)
   5. Palpitations
   6. Transient ischemic episodes
   7. Dyspnea (shortness of breath)
   8. To initiate, revise or discontinue arrhythmia drug therapy.
   9. Evaluation of myocardial infarction (MI) survivors.
   10. Evaluation of acute and subacute forms of ischemic heart disease.
   11. Assessment of patients with coronary artery disease with active symptoms, to correlate chest pain with ST-segment changes.