93288

Interrogation of subcutaneous cardiac rhythm device, in person

CPT code 93288 describes the technical service of an in-person interrogation of a subcutaneous cardiac rhythm device. This includes devices such as subcutaneous implantable cardioverter-defibrillators (S-ICDs) and implantable loop recorders (ILRs). Unlike traditional transvenous devices, these devices are placed entirely under the skin, without leads entering the heart. The interrogation involves using an external programmer device, often a wand or a specific programming head, placed over the patient's skin directly above the implanted device. This non-invasive procedure establishes communication between the external programmer and the implanted device. During the interrogation, stored diagnostic data are retrieved, which can include electrocardiograms (EPGs), detected arrhythmia episodes (e.g., ventricular tachycardia, ventricular fibrillation, asystole, bradycardia, atrial fibrillation), trending data (e.g., heart rate variability, activity levels, P-wave burden for ILRs), and device-specific parameters. The technical service also includes checking the device's battery status, system integrity (e.g., impedance measurements for S-ICDs), and the functionality of sensing and therapy delivery pathways (for S-ICDs). For S-ICDs, the interrogation may involve testing sensing vectors and confirming appropriate shock delivery capabilities without actually delivering a shock. For ILRs, it primarily focuses on event storage and battery life. This code specifically covers the technical work of obtaining and displaying device data, preparing the device for analysis, and making any technical adjustments as directed by a physician. It does not include the medical interpretation and report generation, which are typically billed separately by the physician.

Clinical Indications

  • Routine post-implantation follow-up for subcutaneous ICDs (S-ICDs) or implantable loop recorders (ILRs).
  • Evaluation of patient symptoms (e.g., syncope, palpitations, dizziness) to correlate with device-detected arrhythmias.
  • Assessment of device performance and battery status.
  • Investigation of suspected device malfunction or lead integrity issues (e.g., S-ICD electrode impedance changes).
  • Optimization or adjustment of device programmable parameters (e.g., sensing configurations, therapy zones, antitachycardia pacing for S-ICDs).
  • Pre-MRI evaluation for device compatibility and programming changes.
  • Following an arrhythmia event detected by the device or experienced by the patient, to retrieve stored EPGs and therapy details.
  • Monitoring efficacy of arrhythmia therapy or diagnostic algorithms.
  • Completion of device 'end-of-life' procedures or preparation for device replacement.

Procedure Steps

  1. Patient positioning and preparation, ensuring comfort and access to the device implantation site.
  2. Selection of the appropriate external programmer and programming head/wand for the specific device model.
  3. Placement of the programming head directly over the subcutaneous device to establish communication.
  4. Initiation of the interrogation process through the programmer, typically downloading stored diagnostic data and device parameters.
  5. Review of downloaded data on the programmer screen, including stored EPGs, detected arrhythmia episodes with their corresponding electrograms, and relevant trend data (e.g., heart rate, activity, impedance).
  6. Assessment of device battery voltage and estimated longevity.
  7. Evaluation of system integrity, such as S-ICD electrode impedance values.
  8. Performing diagnostic tests as indicated, which may include sensing vector checks for S-ICDs.
  9. Adjusting programmable parameters of the device (e.g., sensing thresholds, therapy zones, enable/disable features) based on physician orders.
  10. Saving the interrogation session data and printing a technical report for the physician's interpretation.
  11. Disconnecting the programmer and ensuring the patient's comfort and device functionality before discharge.

Coding Guidelines

  • CPT code 93288 represents the technical component of the in-person interrogation of a subcutaneous cardiac rhythm device. It should not be used for remote interrogations.
  • This code is typically reported by the facility (e.g., hospital outpatient department, independent diagnostic testing facility) or by the physician/provider who performs the hands-on technical service.
  • For the professional component (interpretation and report of the interrogation data), a separate CPT code from the 9329x series (e.g., 93290 for S-ICD or 93291 for ILR) is usually reported by the physician responsible for the medical analysis and decision-making.
  • Do not report 93288 for interrogation of transvenous pacemakers (use 93283) or transvenous implantable cardioverter-defibrillators (use 93284).
  • This code should not be reported more frequently than clinically indicated, and often payers have frequency limitations (e.g., once every 90 days for routine checks, but more often if medically necessary for symptom evaluation or device adjustments).
  • When an S-ICD interrogation involves specific programming for MRI compatibility, this code still applies for the technical service.
  • Billing for both the technical (93288) and professional component (e.g., 93290, 93291) during the same encounter is appropriate when performed by different entities or under split billing rules (e.g., facility for technical, physician for professional).

Associated ICD-10 Codes