Resolved 93799

[MICHELLEK_76201]

Hello,

I would like to know if 93799 would be payable for the following ICD-10 as they are not listed in Article A56606 in CMS.GOV

Article - Billing and Coding: Cardiac Event Detection (A56606)

Use this page to view details for the Local Coverage Article for Billing and Coding: Cardiac Event Detection.

www.cms.gov

I25.10
125.110
125.119
I27.0
I27.20
I27.21
I27.22
I27.24
I27.29

Thanks,
Michelle

 

[Alicia]

Most likely you will not get them paid with the use of one of those codes alone. It is a hard stop. Even though they list in
The correct use of an ICD-10 code listed below does not assure coverage of a service. The service must be reasonable and necessary in the specific case and must meet the criteria specified in this determination.

These ICD-10 codes can be used only with the conditions listed in the Coverage Indications, Limitations and/or Medical Necessity section of the Cardiac Event Detection L34573 LCD.
Even though you get a list of codes that will NOT be considered to support medical necessity.
That does not mean you can't try. Here is what was stated in the CPT Assistant Archive.

October 2022 page 16​

Questions and Answers
Medicine: Cardiovascular

Question: What is the appropriate code to report for a procainamide infusion challenge? This procedure was performed in the electrophysiology and catheterization lab in the event that an intervention is needed, but no catheters were placed in the heart. A 12-lead electrocardiography (ECG) device was placed, with V3 and V4 placed one intercostal space above V1 and V2 for a “high V1 and V2” position. Defibrillation pads were also placed and isoprenaline was in the room in the event of any concerning arrhythmias. Procainamide 10 mg/kg was then infused over 30 minutes. Serial ECGs were performed every 15 minutes during the infusion and for 30 minutes after the infusion. There were no ST segment or other ECG changes with infusion of procainamide that would be suggestive of Brugada syndrome. There were no other issues, concerns, or complications during or after the infusion.

Answer: Currently there is no specific CPT code available to report this service. Therefore, code 93799, Unlisted cardiovascular service or procedure, is the appropriate code to report. When reporting an unlisted code to describe a procedure or service, it is necessary to submit supporting documentation (eg, procedure report) along with the claim to provide an adequate description of the nature, extent, and need for the procedure, as well as the time, effort, and equipment necessary to provide the service.