Z95.9 — Presence of cardiac and vascular implant and graft, unspecified
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).
- Regular electronic analysis (interrogation and evaluation of pulse generator status, programmable parameters, event markers, and device response) of implanted pacemakers or cardioverter-defibrillators is medically necessary to evaluate device function.
- Preoperative and postoperative evaluation and potential reprogramming of implanted ICDs or pacer-dependent patients is medically necessary when electromagnetic interference (EMI) or surgical procedures may alter device function.
- Transtelephonic (remote) monitoring of pacemakers is covered according to NCD 20.8.1.1 and may be used in combination with clinic visits, with combined frequency assessed for reasonableness.
- Monitoring of wearable defibrillator systems is covered and paid by DME contractors, with monitoring frequency and indications identical to implantable defibrillator devices.
4 Active Policies
A56602 — Billing and Coding: Cardiac Rhythm Device Evaluation
J12
L34833 — Cardiac Rhythm Device Evaluation
J12
CIGNA-0542 — Duplex Scan of Extracranial Arteries - (0542)
ANTHEM-CG-LAB-21 — CG-LAB-21 Serum Iron Testing
Related Codes
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