Clinical Policy Title: Real-time outpatient cardiac monitoring

Clinical Policy Title: Real-time outpatient cardiac monitoring Clinical Policy Number: 04.01.01 Effective Date: Initial Review Date: Most Recent Revie...
Author: Andrea Ferguson
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Clinical Policy Title: Real-time outpatient cardiac monitoring Clinical Policy Number: 04.01.01 Effective Date: Initial Review Date: Most Recent Review Date: Next Review Date:

September 1, 2013 March 21, 2013 March 16, 2016 March 2017

Policy contains:  Remote non-invasive cardiac event monitoring.  Cardiac outpatient telemetry.  Attended surveillance.

Related policies: CP# 04.01.05

Implantable cardiac loop recorder

ABOUT THIS POLICY: AmeriHealth Caritas Louisiana has developed clinical policies to assist with making coverage determinations. AmeriHealth Caritas Louisiana’s clinical policies are based on guidelines from established industry sources, such as the Centers for Medicare & Medicaid Services (CMS), state regulatory agencies, the American Medical Association (AMA), medical specialty professional societies, and peer-reviewed professional literature. These clinical policies along with other sources, such as plan benefits and state and federal laws and regulatory requirements, including any state- or plan-specific definition of “medically necessary,” and the specific facts of the particular situation are considered by AmeriHealth Caritas Louisiana when making coverage determinations. In the event of conflict between this clinical policy and plan benefits and/or state or federal laws and/or regulatory requirements, the plan benefits and/or state and federal laws and/or regulatory requirements shall control. AmeriHealth Caritas Louisiana’s clinical policies are for informational purposes only and not intended as medical advice or to direct treatment. Physicians and other health care providers are solely responsible for the treatment decisions for their patients. AmeriHealth Caritas Louisiana’s clinical policies are reflective of evidence-based medicine at the time of review. As medical science evolves, AmeriHealth Caritas Louisiana will update its clinical policies as necessary. AmeriHealth Caritas Louisiana’s clinical policies are not guarantees of payment.

Coverage policy AmeriHealth Caritas Louisiana considers the use of real-time outpatient cardiac monitoring (OCM) to be clinically proven and, therefore, medically necessary when all of the following criteria are met: √

Medical necessity criteria (All criteria must be met) Other cardiac-related testing and/or monitoring, recording, and telemetry have been unrevealing. The ordering physician/health care provider must document prior testing performed and the results. For the detection, characterization and documentation of any of the following:  Symptomatic transient or paroxysmal dysrhythmia when the frequency of the symptoms is limited and the use of a 24-hour ambulatory electrocardiogram (ECG) is documented in the medical record to be unlikely to capture and record a non-life-threatening dysrhythmia.  Other paroxysmal supra-ventricular arrhythmias.  Evaluation of various brady arrhythmias.  Intermittent bundle branch block.


√   

Medical necessity criteria (All criteria must be met) Individuals recovering from cardiac surgery who have had documented atrial arrhythmias. Individuals with symptomatic underlying structural disease. Individuals with no structural heart disease but who have recurrent severe symptoms (i.e., recurrent syncope), in whom all testing is negative and an implantable event recorder is contemplated. Individuals with uncontrolled atrial fibrillation post-pneumonectomy.

Prolonged monitoring is required specifically to ensure the absence of asymptomatic arrhythmias or QT interval or ST changes including, but not limited to, any of the following conditions:  Recurrence of atrial fibrillation prior to the discontinuation of anticoagulation therapy.  Drug response for those receiving antiarrhythmic therapy.  Pro-arrhythmia associated with anti-arrhythmic and other medication.  Silent ischemia for those requiring anti-ischemic therapy.

Limitations: 

 

All other uses of real-time OCM are not medically necessary. Examples include, but are not limited to, the following: o When real-time OCM is unlikely to provide clinical data or information beyond that which has already been obtained from a previous test, or if other testing could be expected to provide the data and/or information needed for the diagnosis or treatment of the patients symptoms and condition (e.g., 24-hour Holter monitor). o For individuals considered to be at high risk for clinically significant recurrent dysrhythmias (e.g., ventricular tachycardia or ventricular fibrillation). o Screening. o With a Holter monitor, or other event recorder, performed on the same individual on the same day. o As outpatient monitoring in an individual recently discharged from a facility immediately following a myocardial infarction. o In anyone with potentially life-threatening arrhythmias that require inpatient monitoring. Qualified personnel must provide surveillance in receiving centers and direction in emergent situations. When use of OCM extends beyond 30 consecutive days, OCM is limited to a maximum of two 30-consecutive day periods within a 12-month time frame.

Alternative covered services:    

Holter monitor. Implantable real-time cardiac monitors. In-hospital cardiac telemetry. Oral pharmacotherapy.


Background Abnormal heart rhythms, known as cardiac arrhythmias, are marked by symptoms such as palpitations, dizziness, or fainting episodes. Changes in heart rate may also occur resulting in bradycardia, which is a heart rate below 60 beats per minute, or tachycardia, which is a heart rate abnormally rapid and, depending on the specific etiology, is commonly defined as greater than 100 to 200 beats per minute. Cardiac arrhythmias may go undetected, may occur at any time, and may be unpredictable in nature, making a correct diagnosis a difficult task. Effective clinical treatment and management are dependent upon an accurate diagnosis. Cardiac monitoring devices have been developed to assist in the diagnosis of arrhythmias. Cardiac event recorders that require individual patient input are only as good as the individual’s ability to recognize an arrhythmia and activate the unit. Outpatient Holter monitors are short-term and limited by their ability to record ECG information for up to 48 hours. The short duration and capacity of a Holter monitor limits its diagnostic yield; as such, it is most appropriate for recording episodes that occur at least on a daily basis. Real-time OCM: Real-time OCM has been developed for patients for whom a longer period of time is needed to identify arrhythmias for a definite diagnosis. These devices provide continuous outpatient ECG monitoring for weeks, up to a one month (30 days) period, and are used to monitor heart rhythm outside a facility setting for people with nonlife threatening cardiac arrhythmias. A real-time OCM uses an automatically activated system that does not need human action to either capture or transmit dysrhythmic episode information. These monitors have an extended memory and an automatic real-time event notification ability that may use either computer dialing of conventional landlines, or cellular communication technology. The notification ability relies on a computer program that continually analyzes heart rhythm data as they are received. The monitor automatically transmits ECG recorded data to a central station where the program detects an arrhythmia. The individual wearing the monitor may also transmit symptoms to the central station for further analysis. The automatic activation enables a rapid telephonic submission to a perpetually manned (attended) receiving station (surveillance) and an immediate interpretation of irregular heart rhythm activity by ECG. The American Medical Association (AMA) defines attended surveillance as the immediate availability of a remote technician to respond to rhythm or device alert transmissions from a patient, either from an implanted or wearable monitoring or therapy device, as they are generated and transmitted to the remote surveillance center (AMA, 2014). Several United States Food and Drug Administration (FDA)-approved devices classified as an arrhythmia detector and alarm (including ST-segment measurement and alarm, product code DSI) are available for marketing in the United States. Emerging technology includes new devices in this category that are wireless, implantable ECG monitors with real-time monitoring capability. Searches AmeriHealth Caritas Louisiana searched PubMed and the databases of:  UK National Health Services Centre for Reviews and Dissemination.  Agency for Healthcare Research and Quality’s National Guideline Clearinghouse and other evidence-based practice centers.  The Centers for Medicare & Medicaid Services (CMS).


We conducted searches in February 2014, March 26, 2015 and March 3, 2016. Search terms were: “Cardiac monitoring,” "Arrhythmias, Cardiac/analysis"[MeSH], and "Arrhythmias, Cardiac/diagnosis"[MeSH]. We included:  Systematic reviews, which pool results from multiple studies to achieve larger sample sizes and greater precision of effect estimation than in smaller primary studies. Systematic reviews use predetermined transparent methods to minimize bias, effectively treating the review as a scientific endeavor, and are thus rated highest in evidence-grading hierarchies.  Guidelines based on systematic reviews.  Economic analyses, such as cost-effectiveness, and benefit or utility studies (but not simple cost studies), reporting both costs and outcomes — sometimes referred to as efficiency studies — which also rank near the top of evidence hierarchies. Findings Studies of the clinical utility of outpatient cardiac monitoring have been of various sizes and duration. Kadish et al studied 26,438 patients who had undergone outpatient cardiac telemetry (OCT) during a ninemonth period, tracking how many events transmitted by these monitors measured emergent arrhythmias (Kadish, 2010). Of these patients, 5,459 (21 percent) had an arrhythmic event that required physician notification, and 262 (one percent) patients had an event that would be considered to be potentially emergent. The potentially emergent events included 42 with sustained bradycardia at less than 30 heart beats per minute, 100 patients with sinus pauses of six seconds or longer, and 120 patients with widecomplex tachycardia. Lack of an appropriate comparison group limited the results of this and other studies, and does not allow for conclusions regarding benefit of testing over and beyond that offered by current medical standards. One randomized controlled trial (RCT) compared the diagnostic yield of an outpatient telemetry system (CardioNet Mobile Cardiac Outpatient Telemetry™ [MCOT], Malvern, PA) to patient-activated external looping event monitors in patients with symptoms suggestive of a significant cardiac arrhythmia(s) (Rothman, 2007). The study engaged 18 centers with patients randomized to either MCOT or standard loop event monitoring for up to 30 days. The study subjects presented with symptoms of severe palpitations (81 percent) with a non-diagnostic 24-hour Holter monitor, pre-syncope (33 percent), or syncope (16 percent). The primary endpoint was the exclusion or confirmation of a probable arrhythmic cause of the participant’s symptoms. Secondary endpoints included the detection of non-symptomatic and symptomatic clinically significant arrhythmias and the length of time to diagnosis. A total of 266 participants completed the monitoring period. Diagnosis was made in 88 percent of the MCOT participants compared to 75 percent if the participants with standard loop recorders. In a subgroup of participants presenting with pre-syncope, or syncope, a diagnosis was made in 89 percent of the MCOT subjects compared to 69 percent of the LOOP subjects. MCOT was superior to standardized loop monitoring in detecting symptoms suggestive of significant cardiac arrhythmias (38 percent versus 14 percent, respectively). These results suggest that real-time OCM is superior to a patient-activated external loop recorder for detecting and diagnosing cardiac arrhythmias (Rothman, 2007). In a guideline on the management of atrial fibrillation (AF), the National Institute for Health and Clinical Excellence (NICE) recommends the following in patients with suspected paroxysmal AF that is undetected by standard ECG recording (NICE, 2006):


 

A 24-hour ambulatory ECG monitor should be used for those individual with suspected asymptomatic episodes or symptomatic episodes less than 24 hours apart. An event recorder ECG should be used in those individuals with symptomatic episodes more than 24 hours apart.

The American College of Cardiology (ACC)/American Heart Association (AHA)/European Society of Cardiology (ESC) ventricular arrhythmia guidelines make a distinction between the indications for continuous 24- to 48-hour Holter monitoring and intermittent monitoring with event (Zipes, 2006). Based on class one, level A evidence, the use of ambulatory ECG is appropriate when there is a need to clarify the diagnosis by detecting arrhythmias, QT-interval changes, T-wave alternans or ST changes to evaluate risk, or to judge therapy. Event monitors are indicated when symptoms are sporadic and related to arrhythmias such as syncope, when a symptom-rhythm correlation cannot be established by conventional diagnostic methods. A 24- to 48-hour Holter monitor is appropriate whenever the arrhythmia is known or suspected to occur at least once a day (Zipes, 2006). For sporadic episodes producing dizziness, syncope or palpitations, conventional event monitors are more appropriate because they are able to record over longer periods of time. Continuously recording monitors that have both patient-activated and automatic triggers appears to improve the diagnostic yield of event monitors (Strickberger, 2006; Zipes, 2006). In an Agency for Healthcare Research and Quality (AHRQ) technology assessment, a clinical competence statement on remote cardiac monitoring suggests that the frequency of symptoms may guide physician decisions about which type of monitoring to use for a particular individual (AHRQ, 2007). For individuals with infrequent symptoms, intermittent event recorders may be more cost-effective. Continuous recording devices are recommended for individuals with daily symptoms that may be related to recurrent, unexplained palpations, heart rhythm disturbances, syncope or near syncope episodes. Continuous monitoring is also indicated for individuals receiving antiarrhythmic therapy in order to assess drug response, monitor the rate of atrial fibrillation, exclude pro-arrhythmia, assess silent ischemia and monitor anti-ischemia therapy (AHRQ, 2007). In the diagnosis of patients with symptoms of a cardiac arrhythmia, real-time OCM provides a significantly higher yield than standard cardiac loop recorders. This result was more pronounced in patients presenting with symptoms of syncope or presyncope. OCM was superior to loop recorders for the detection of clinically significant arrhythmias, with a shorter time to diagnosis. Policy updates: AmeriHealth Caritas Louisiana identified one new guideline, but no new systematic reviews or economic analyses for this policy update. The Pediatric and Congenital Electrophysiology Society (PACES) and the Heart Rhythm Society (HRS) Expert Consensus Statement on the Recognition and Management of Arrhythmias in Adult Congenital Heart Disease concurs with guidelines identified in the original policy findings (Khairy, 2014). Indications for ambulatory monitoring and selection of recording technique in symptomatic patients with congenital heart disease are similar to those for the general population. Standard Holter monitoring is best suited for the evaluation of daily symptoms or arrhythmias. Noninvasive devices capable of longer-duration continuous recordings (typically two to four weeks) are best suited for evaluating sporadic symptoms such as syncope. Although data are limited, in select cases where the index of suspicion for a malignant arrhythmia is high but noninvasive monitoring in not feasible or has been unrevealing, an implantable loop recorder may prove valuable (Khairy, 2014). AmeriHealth Caritas Louisiana identified no new systematic reviews, guidelines or economic analyses for the 2016 policy update. Therefore, no changes to the policy are warranted. 5

Summary of clinical evidence: Citation

Content, Methods, Recommendations

Vasamreddy (2006)

Key points:   

Turakhia (2013)

Feasibility and results of an exploratory study (n = 19) using OCM for monitoring patients with atrial fibrillation before and after catheter ablation for atrial fibrillation. The authors concluded that MCT has potential utility for this use. The authors noted, however, that poor patient compliance with the study's MCT monitoring protocol represented an important limitation; only 10 of 19 subjects that were enrolled in the study completed the protocol, which required subjects to wear the MCT monitor five days per month for six months following the ablation.

Key points: 

Compliance, analyzable signal time, interval to arrhythmia detection, and diagnostic yield of the Zio Patch, a novel leadless, ECG monitoring device in 26,751 consecutive patients. The mean wear time was 7.6 ± 3.6 days, and the median analyzable time was 99% of the total wear time. Among the patients with detected arrhythmias (60.3% of all patients), 29.9% had their first arrhythmia and 51.1% had their first symptom-triggered arrhythmia occur after the initial 48-hour period. Compared with the first 48 hours of monitoring, the overall diagnostic yield was greater when data from the entire Zio Patch wear duration were included for any arrhythmia (62.2% versus 43.9%, p < 0.0001) and for any symptomatic arrhythmia (9.7% versus 4.4%, p < 0.0001). For paroxysmal atrial fibrillation (AF), the mean interval to the first detection of AF was inversely proportional to the total AF burden, with an increasing proportion occurring after 48 hours (11.2%, 10.5%, 20.8% and 38.0% for an AF burden of 51% to 75%, 26% to 50%, 1% to25 %, and less than 1%, respectively). The authors concluded that extended monitoring with the Zio Patch for less than or equal to 14 days is feasible, with high patient compliance, a high analyzable signal time, and an incremental diagnostic yield beyond 48 hours for all arrhythmia types. These findings could have significant implications for device selection, monitoring duration and care pathways for arrhythmia evaluation and AF surveillance.

Glossary Cardiac arrhythmia — An irregular heartbeat. Holter monitor — A portable device used for 24-hour to 48-hour continuous monitoring of heart rhythm. Medically necessary — A service or benefit is medically necessary if it is compensable under the Medical Affairs Program and if it meets any one of the following standards: 6

  

The service or benefit will, or is reasonably expected to, prevent the onset of an illness, condition or disability. The service or benefit will, or is reasonably expected to, reduce or ameliorate the physical, mental or developmental effects of an illness, condition, injury or disability. The service or benefit will assist the Member to achieve or maintain maximum functional capacity in performing daily activities, taking into account both the functional capacity of the Member and those functional capacities that are appropriate for Members of the same age.

OCM — Outpatient (mobile) cardiac monitoring. Telemetry — The recording and transmission of data regarding the electrical activity and functioning of the heart; an OCM transmits the data to a 24 hour, professionally staffed monitoring center. References Professional society guidelines/other: Khairy P, Van Hare GF, Balaji S, et al. PACES/HRS expert consensus statement on the recognition and management of arrhythmias in adult congenital heart disease: developed in partnership between the Pediatric and Congenital Electrophysiology Society (PACES) and the Heart Rhythm Society (HRS). Endorsed by the governing bodies of PACES, HRS, the American College of Cardiology (ACC), the American Heart Association (AHA), the European Heart Rhythm Association (EHRA), the Canadian Heart Rhythm Society (CHRS), and the International Society for Adult Congenital Heart Disease (ISACHD). Can Jour Cardiol. 2014;30(10):e1 – e63. Moya A, Sutton R, Ammirati F, et al. Guidelines for the diagnosis and management of syncope (version 2009). Eur Heart J. 2009;30(21):2631 – 2671. Strickberger SA, Benson DW, Biaggioni I, et al. AHA/ACCF scientific statement on the evaluation of syncope: from the American Heart Association Councils on Clinical Cardiology, Cardiovascular Nursing, Cardiovascular Disease in the Young, and Stroke, and the Quality of Care and Outcomes Research Interdisciplinary Working Group; and the American College of Cardiology Foundation In Collaboration With the Heart Rhythm Society. J Am Coll Cardiol. 2006;47(2):473 – 484. Tracy CM, Epstein AE, Darbar D, et al. 2012 ACCF/AHA/HRS focused update of the 2008 guidelines for device-based therapy of cardiac rhythm abnormalities: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines and the Heart Rhythm Society. [corrected]. Circulation. 2012;126(14):1784 – 1800. Zipes DP, Camm AJ, Borggrefe M, et al. ACC/AHA/ESC 2006 Guidelines for Management of Patients With Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death: a report of the American College of Cardiology/American Heart Association Task Force and the European Society of Cardiology Committee for Practice Guidelines (writing committee to develop Guidelines for Management of Patients With Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death): developed in collaboration with the European Heart Rhythm Association and the Heart Rhythm Society. Circulation. 2006;114(10):e385 – 484.


Peer-reviewed references: Agency for Healthcare Research and Quality (AHRQ). Remote cardiac monitoring. Technology Assessment. Prepared for the AHRQ by the ECRI Evidence-based Practice Center (EPC). Contract No. 290-02-0019. Rockville, MD: AHRQ; Dec 12, 2007. AHRQ website. Accessed March 3, 2016. American Medical Association (AMA). CPT® Current Procedural Terminology 2014. Standard edition. Chicago, IL: American Medical Association; 2014. CardioNet Ambulatory ECG Monitor with arrhythmia detection Model CN 1004 510(k) summary. FDA Center for Devices and Radiologic Health 510(k) Premarket Notification database website. Available at: Accessed March 3, 2016. CardioNet Arrhythmia Detector and Alarm 510(k) summary. FDA Center for Devices and Radiologic Health 510(k) Premarket Notification database website. Available at: Accessed March 26, 2015. Joshi AK, Kowey PR, Prystowsky EN, et al. First experience with a Mobile Cardiac Outpatient Telemetry (MCOT) system for the diagnosis and management of cardiac arrhythmia. Am J Cardiol. 2005;95(7):878 – 881. Kadish AH, Reiffel JA, Clauser J, et al. Frequency of serious arrhythmias detected with ambulatory cardiac telemetry. Am J Cardiol. 2010;105(9):1313 – 1316. Krahn AD, Klein GJ, Yee R, Skanes AC. Randomized assessment of syncope trial: conventional diagnostic testing versus a prolonged monitoring strategy. Circulation. 2001;104(1):46 – 51. Kumar S, Kambhatla K, Hu F, Lifson M, Xiao Y. Ubiquitous computing for remote cardiac patient monitoring: a survey. Int J Telemed Appl. 2008:459185. Accessed March 3, 2016. LifeStar ACT (LifeWatch®, Inc., subsidiary of Card Guard Scientific) CG-6108 Arrhythmia ECG Event Recorder 510(k) summary. FDA Center for Devices and Radiologic Health 510(k) Premarket Notification database website. Accessed March 3, 2016. Mobile cardiac telemetry. LifeWatch website. Accessed March 3, 2016. Rockx MA, Hoch JS, Klein GJ, et al. Is ambulatory monitoring for "community-acquired" syncope economically attractive? A cost-effectiveness analysis of a randomized trial of external loop recorders versus Holter monitoring. Am Heart J. 2005;150(5):1065. Rothman SA, Laughlin JC, Seltzer J, et al. The diagnosis of cardiac arrhythmias: a prospective multi-center randomized study comparing mobile cardiac outpatient telemetry versus standard loop event monitoring. J Cardiovasc Electr. 2007;18(3):241 – 247.


The CardioNet Ambulatory ECG Monitor with Arrhythmia Detection Model CN1001 510(k) summary. FDA Center for Devices and Radiologic Health 510(k) Premarket Notification database website. Modifications to the device in subsequent approvals (product code DSI). Both sites accessed March 3, 2016. The HEARTLink™ II ECG Arrhythmia Detector and Alarm System by the Cardiac Telecom Corporation 510(k) summary. FDA Center for Devices and Radiologic Health 510(k) Premarket Notification database website. Accessed March 3, 2016. Welcome to CardioNet. CardioNet website. Accessed March 3, 2016. Clinical trials: Searched on March 3, 2016 using terms Open Studies | arrhythmia OR flutter OR fibrillation OR syncope | monitor. 35 studies found, three relevant trials. Comparison of Continuous Sternal ECG Patch Monitors (Carnation and Zio) Trial. website. Published January 8 2014. Updated June 25, 2014. Accessed March 3, 2016. Diagnostic Device Risk Management of Atrial Fibrillation and Heart Failure. website. Published November 4 2011. Updated November 8, 2013. Accessed March 3, 2016. REVEAL AF: Incidence of AF in High Risk Patients. website. Published November 12 2012. Updated December 3, 2013. Accessed March 3, 2016. CMS National coverage determination (NCDs): NCD 20.15 Electrocardiographic Services. CMS website. Accessed March 3, 2016. CAG-00158N Electrocardiographic Services. CMS website. Accessed March 3, 2016. Local coverage determinations (LCDs): L34636. Electrocardiographic (EKG or ECG) Monitoring (Holter or Real-Time Monitoring). CMS website. All&KeyWord=RealTime+Monitoring&KeyWordLookUp=Title&KeyWordSearchType=Exact&kq=true&bc=IAAAABAAAAAAAA%3 d%3d&. Accessed March 3, 2016.


Commonly submitted codes Below are the most commonly submitted codes for the service(s)/item(s) subject to this policy. This is not an exhaustive list of codes. Providers are expected to consult the appropriate coding manuals and bill accordingly. CPT Code



External mobile cardiovascular telemetry with electrocardiographic recording, concurrent computerized real time data analysis and greater the n24 hours of accessible ECG data storage ( retrievable with query) with ECG triggered and patient selected events transmitted to a remote attended surveillance center for up to 30 days; review and interpretation with report by a physician or other qualified health care professional


ICD-9 Code 426.1 426.2 426.3 426.10 426.11 426.12 426.13 427.0 427.1 427.2 427.31 427.32 427.41 427.42 427.5 427.60 427.61 427.69 427.81 427.89 427.9 428.0 428.1 428.20 428.21 428.22 428.23 428.30 428.31 428.32 428.33 428.40

Technical support for connection and patient instructions for use, attended surveillance, analysis and transmission of daily and emergent data reports as prescribed by a physician or other qualified health care professional



Only once per 30 days


Atrioventricular block other and unspecified Left bundle branch hemiblock Other left bundle branch block Atrioventricular block, unspecified First degree atrioventricular block Mobitz (type) II atrioventricular block Other second degree atrioventricular block Paroxysmal supraventricular tachycardia Paroxysmal ventricular tachycardia Paroxysmal tachycardia unspecified Atrial fibrillation Atrial Flutter Ventricular fibrillation Ventricular flutter Cardiac arrest Premature beats unspecified Supraventricular premature beats Other premature beats Sinoatrial node dysfunction Other specified cardiac dysrhythmias Cardiac dysrhythmia, unspecified Heart failure Left heart failure Unspecified systolic heart failure Acute systolic heart failure Chronic systolic heart failure Acute on chronic systolic heart failure Unspecified diastolic heart failure Acute diastolic heart failure Chronic diastolic heart failure Acute on chronic diastolic heart failure Unspecified combined systolic and diastolic heart failure


428.41 428.42 428.43 428.9 ICD-10 Code I50.21 I50.22 I50.23 I50.31 I50.32 I50.33 I50.40 I50.41 I50.42 I50.1 I50.20 I50.21 I50.22 I50.23 I50.30 I50.31 I50.32 I50.33 I50.40 I50.41 I50.42 780.2 I49.2 I47.1 I47.0 I47.2 I47.9 I48.2 I48.0 I48.1 I48.4 148.92 I49.01 I49.02 I46.8 I46.2 I46.9 I49.90 I49.1

Acute combined systolic and diastolic heart failure Chronic combined systolic and diastolic heart failure Acute on chronic combined systolic and diastolic heart failure Heart failure, unspecified Description


Acute Heart Failure Chronic systolic (congestive) hear failure Acute on chronic systolic (congestive) heart failure Acute diastolic (congestive) heart failure Chronic diastolic (congestive) heart failure Acute on chronic diastolic (congestive) heart failure Unspecified combined systolic (congestive) and diastolic (congestive) heart failure Acute combined systolic (congestive) and diastolic (congestive) heart failure Chronic combined systolic (congestive) and diastolic (congestive) heart failure Left ventricular failure Unspecified systolic (congestive) heart failure Acute Heart Failure Chronic systolic (congestive) hear failure Acute on chronic systolic (congestive) heart failure Unspecified diastolic (congestive) heart failure Acute diastolic (congestive) heart failure Chronic diastolic (congestive) heart failure Acute on chronic diastolic (congestive) heart failure Unspecified combined systolic (congestive) and diastolic (congestive) heart failure Acute combined systolic (congestive) and diastolic (congestive) heart failure Chronic combined systolic (congestive) and diastolic (congestive) heart failure Syncope and collapse Junctional premature depolarization Supraventricular tachycardia Re-entry ventricular arrhythmia Ventricular tachycardia Paroxysmal tachycardia, unspecified Chronic atrial fibrillation Paroxysmal atrial fibrillation Persistent atrial fibrillation Atypical atrial flutter Unspecified atrial flutter Ventricular fibrillation Ventricular flutter Cardiac arrest due to other underlying condition Cardiac arrest due to underlying cardiac condition Cardiac arrest cause unspecified Unspecified premature depolarization Atrial premature depolarization


I49.3 I49.49 I49.5 R00.1 I49.8 149.9 I44.2 I44.30 I44.39 I44.4 I44.5 I44.60 I44.69 I44.7 HCPCS Level II

Ventricular premature depolarization Other premature depolarization Sick sinus syndrome Bradycardia, unspecified Other specified cardiac arrhythmias Cardiac arrhythmia, unspecified Atrioventricular block, complete Unspecified atrioventricular block Other atrioventricular block Left anterior fascicular block Left posterior fascicular block Unspecified fascicular block Other fascicular block Left bundle –branch block, unspecified Description




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