External electrocardiographic recording >48 hours up to 21 days by continuous rhythm recording and storage; includes recording, scanning analysis with report, review and interpretation
Audit Defense & Denial Intelligence
Research-based denial patterns from OrbDoc Bill Analyzer
1. Extended ECG monitoring duration not justified by symptom frequency
Common93225 (external ECG >48 hours up to 21 days) for symptoms occurring several times per week but not daily. More expensive than 24-48 hour Holter. Denied when symptom frequency would be captured by shorter monitor, when too infrequent for any monitor (need implantable loop recorder), or when diagnosis already established.
Common Causes
- • Symptoms daily - 24-48 hour Holter adequate, extended monitoring unnecessary
- • Symptoms monthly - too infrequent for external monitor, need implantable loop recorder
- • No specific symptoms, routine screening - not medically necessary
Resolution Strategy
Document symptoms 2-3 times per week: 'Patient reports episodes of palpitations and presyncope 2-3 times weekly, unpredictable timing. Prior 48-hour Holter without symptoms, non-diagnostic. Extended cardiac monitoring (14-day) ordered to increase capture probability. Day 5: Patient reported palpitations, correlating with 6-beat run of NSVT. Day 9: Lightheadedness episode correlating with 3-second sinus pause. Diagnosed with sinus node dysfunction, referred for pacemaker evaluation.' Must specify: symptom frequency (2-3x/week for extended), prior shorter monitoring non-diagnostic, monitoring duration matches symptom frequency, findings. If symptoms daily, 24-48 hour adequate. If monthly, implantable loop recorder needed.
Relative Value Units (RVUs)
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Clinical Information
When to Use
For continuous ECG monitoring greater than 48 hours up to 21 days with analysis and interpretation
Common Scenarios
Documentation Requirements
- Indication for extended monitoring
- Duration of monitoring
- Patient diary documentation
- Analysis findings and report
- Interpretation and recommendations
Coding Guidelines
Common Modifiers
Bundling Rules
- Includes >48 hours up to 21 days monitoring
- Includes analysis and interpretation
- Shorter monitoring requires separate code
- Event monitor coded separately
- ECG coded separately
Exclusions
- 93224 (external ECG recording up to 48 hours)
- 93226 (external ECG recording >48 hours, analysis with report only)
- 93227 (external ECG recording >48 hours, review and interpretation only)
- 93268 (external patient-activated loop recorder)
Coding Notes
Clinical scenarios
- Indication for extended monitoring
- Duration of monitoring
- Patient diary documentation
- Indication for extended monitoring
- Duration of monitoring
- Patient diary documentation
- Indication for extended monitoring
- Duration of monitoring
- Patient diary documentation
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Code Details
Medicare Pricing
PFSRVU Breakdown
OPPS Details
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Ask a QuestionFrequently Asked Questions
CPT 93225 is the billing code for "External electrocardiographic recording >48 hours up to 21 days by continuous rhythm recording and storage; includes recording, scanning analysis with report, review and interpretation". For continuous ECG monitoring greater than 48 hours up to 21 days with analysis and interpretation
Medicare pays approximately $17.47 for CPT 93225 (national average). Actual payment varies by geographic location due to GPCI adjustments. Hospital and commercial insurance rates are typically 2-4x higher than Medicare rates.
CPT 93225 has a total RVU of 6.70, broken down as: Work RVU 2.00, Practice Expense RVU 4.50, and Malpractice RVU 0.20. RVUs (Relative Value Units) determine Medicare reimbursement rates.
The most common denial reason for CPT 93225 is "Extended ECG monitoring duration not justified by symptom frequency". 93225 (external ECG >48 hours up to 21 days) for symptoms occurring several times per week but not daily. More expensive than 24-48 hour Holter. Denied when symptom frequency would be captured by shorter monitor, when too infrequent for any monitor (need implantable loop recorder), or when diagnosis already established. Common causes include: Symptoms daily - 24-48 hour Holter adequate, extended monitoring unnecessary; Symptoms monthly - too infrequent for external monitor, need implantable loop recorder. Appeal success rate is approximately 40-60%.
Key documentation requirements for CPT 93225 include: Indication for extended monitoring; Duration of monitoring; Patient diary documentation; Analysis findings and report. Missing or incomplete documentation is a leading cause of claim denials for this code.
Bundling considerations for CPT 93225: Includes >48 hours up to 21 days monitoring. Includes analysis and interpretation Use an NCCI bundling checker to verify specific code combinations before billing.
Common modifiers for CPT 93225 include: 26 (Professional component only (interpretation)), TC (Technical component only (equipment/staff)), 59 (Distinct procedural service if performed separately). Modifiers indicate special circumstances and can affect reimbursement or prevent claim denials.
The typical time requirement for CPT 93225 is >48 hours up to 21 days monitoring period. Time-based codes require documentation of the actual time spent providing the service.