Z95.810 — Presence of automatic (implantable) cardiac defibrillator
ICD-10-CM
Prior Authorization
No Prior Auth Required
Code is covered without prior authorization (high confidence)
Documentation Required
- All documentation must be maintained in the patient's medical record and made available to the contractor upon request.
- Every page of the record must be legible and include appropriate patient identification information, including complete name and dates of service.
- The documentation must include the legible signature of the physician or non-physician practitioner responsible for and providing the patient's care.
- The submitted medical record must support the use of the selected ICD-10-CM code(s).
Key Coverage Criteria
- When billing Medicare Part B for analysis of a Wearable Defibrillator System, report CPT code 93292.
- Report CPT codes 93260, 93261, and 93279-93292 when performing the corresponding cardiac rhythm device evaluation procedures (reported per procedure).
- Interrogation (in-person, remote/web-based, or device transmission) of implantable or wearable cardioverter defibrillators (ICDs) is covered when medically necessary and supported by documentation of the ordering provider's assessment, relevant history, and pertinent test results.
- In-person interrogation is covered for evaluation of clinical symptoms or device issues and may be performed as clinically appropriate based on symptomatology.
- Remote interrogation services (including internet/web-based surveillance) are covered as a surveillance modality when documented and billed per applicable coding rules.
- An ECG is covered when the result is relevant to the management, diagnosis, or treatment of the patient.
17 Active Policies
A56602 — Billing and Coding: Cardiac Rhythm Device Evaluation
J12
L34833 — Cardiac Rhythm Device Evaluation
J12
AETNA-CPB-0019 — Holter Monitors
AETNA-CPB-0021 — Cardiac Rehabilitation: Outpatient
ANTHEM-CG-MED-40 — CG-MED-40 External Ambulatory Cardiac Monitors
Related Codes
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