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Clinical Applications
It is a known fact that heart disease is
the number one killer in America. Most of the deaths are
related to ventricular
arrhythmia
or coronary artery disease with silent
ischemia.
Many of the persons afflicted are relatively young with
no prior symptom or premonition of heart disease. The
changing climate of health care in recent years, with
the growing emphasis on cost containment is forcing
healthcare professions to look for alternative means of
health care delivery.
For these reasons, the use of the TTM
for the diagnostic evaluation and management of a great
number of patients with suspected or documented cardiac
problems can be justifiably regarded as an alternative
to meeting the socioeconomic and the medical challenges.
Specific
Applications & Examples
1. Specific Symptom Evaluation
-
dizziness or light-headedness; Syncope; “Weak
Spells” “Pounding in chest”;
Palpitations; Fluttering; “Flip-flops in chest”.
- Chest
Pain or Tightness; “Heaviness in Chest”;
Epigastric Pain; “Indigestion-like pain”
-
shortness of breath with or without exertion;
“sensations of choking”; episodic diaphoresis
2. Evaluation of specific clinical
situations
- Post myocardial infarction patients
- Post
angioplasty PTCA patients
- Post CABG
Patients
- Post permanent pacer insertion:
* Evaluation of possible pacer malfunction
* Evaluation of activity dependent pacemaker function
- Unstable
Angina; Evaluation of silent
ischemia
BI-Fascicular or Tri-Fascicular conduction system
disease.
- Evaluation of automatic implanted defibrillator
function
3. Evaluation of rate, rhythm, or
ECG interval
changes during drug titration
- Initiation of anti-arrhythmic medication (evaluate
specific ECG
interval changes, rate changes, or rhythm conversions)
- Optimizing medication dose (e.g.: Adjustment of
Digoxin, Ca++ Blockers, Beta-blockers)
- Discontinuation of cardiac medication (evaluate
the effects of stopping specific cardiac medication on
rate and rhythm).
4. Evaluation of rate or
ECG interval
changes during specific activities
- Specific Activities of daily living (walking,
after meals, etc.)
- During specific activities associated with
increased mental stress or job related stress.
Insurance
Coverage
TTM is covered by most insurance
carriers. It is also known as cardiac event monitoring
and Transtelephonic ECG. Coverage by Medicare is
included for the following ICD-9 codes:
TTM is billed under the Medicare CPT
codes of G0004, G0006, G0015 and G0016. Additional CPT
codes apply to hook-up, physician interpretation. The
following CPT codes are associated with this procedure:
-
93012 Telephonic transmission of
post-symptom electrocardiogram rhythm strip(s), per 30
day period of time; tracing only
-
93014 ; physician review with
interpretation and report only
-
93268 Patient demand single or
multiple event recording with presymptom memory loop,
per 30 day period of time; includes transmission,
physician review and interpretation
-
93270 ; recording (includes hook-up,
recording, and disconnection) 93271 ; monitoring,
receipt of transmissions, and analysis
-
93272 ; physician review and
interpretation only
-
G0004 Patient demand single or
multiple event recording with pre-symptom memory loop
and 24-hour attended monitoring, per 30 day period;
includes transmission, physician review and
interpretation
-
G0005 ; recording (includes hook-up,
recording and disconnection)
-
G0006 ; 24-hour attended monitoring,
receipt of transmissions and analysis
-
G0007 ; physician review and
interpretation only
-
G0015 Post-symptom telephonic
transmission of electrocardiogram rhythm strip(s) and
24-hour attended monitoring, per 30 day period;
tracing only
-
G0016 ; physician review and
interpretation only
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