Billing and Coding: Cardiac Event Detection

This billing and coding guidance requires valid ICD-10-CM diagnosis codes and appropriate reporting of referring/ordering physician name and NPI; procedure codes may be subject to NCCI or OPPS edits. Use ABN-related modifiers (-GA, -GX, -GZ, -GY) per the anticipated reason for denial, follow ABN (Form CMS-R-131) and Part A occurrence code 32 requirements when applicable, and ensure medical records include assessment, history, test results, and signed dated documentation.

"A claim submitted without a valid ICD-10-CM diagnosis code will be returned as an incomplete claim under Section 1833(e) of the Social Security Act."

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