Getting the Edge on Coding Electrophysiology
Deborah C. Hall, CPC
Coding electrophysiology (EP) services and procedures can be difficult because many are performed in the EP lab. In addition, health information management (HIM) personnel often are not aware of which services or procedures can be coded nor of the appropriate codes to use.
CPT codes 93619 through 93660 can be used for intracardiac electrophysiologic procedures and services. This code range includes studies performed to treat arrhythmias, which includes evaluating them as well as cardioverter-defibrillator function, and ablating the arrhythmogenic or node function.
The major types of EP procedures and services included within this code range are reviewed below.
Use codes 93619 through 93622 when describing diagnostic EP studies that are most commonly performed for:
* syncope of uncertain origin;
* known or suspected supraventricular tachycardias;
* assessing properties of atrioventricular conduction; and
* evaluating known or suspected ventricular tachycardias.
Typically, code 93619 is used when multiple transvenous electrode catheters are inserted and positioned high in the right antrium, HIS bundle region and right ventricle. Do not code this procedure separately when the following are performed and conduction intervals are measured: right atrial pacing and recording, bundle of HIS recording and right ventricular pac-ing.
Code 93619 also can be assigned when the physician performs vascular access, sedation and monitoring; inserts and repositions catheters; adjusts the pacing of the different heart chambers; and removes catheters.
93619 Comprehensive electrophysiologic evaluation with right atrial pacing and recording, right ventricular pacing and recording, HIS bundle recording, including insertion and repositioning of multiple electrode catheters; without induction or attempted induction of arrhythmia (This code is to be used when 93600 is combined with 93602, 93603, 93610, 93612.)
You can use code 93620 when services in addition to those listed in code 93619 are performed. Specifically, 93620 is ap-propriate when the physician also in- duces or attempts to induce the arrhyth-mia (as covered by 93618). In other words, 93620 is used to indicate the services defined in 93619 and 93618, when they are performed during the same encounter.
93620 Comprehensive electrophysiologic evaluation with right atrial pacing and recording, right ventricular pacing and recording, HIS bundle recording, including insertion and repositioning of multiple electrode catheters; with induction or attempted induction of arrhythmia (This code is to be used when 93618 is combined with 93619.)
Presently, there is no CPT code to indicate the placement of a single coronary sinus catheter without the comprehensive study because this is rarely performed. If the physician does perform this service, the American College of Cardiology suggests that codes 93602 and 93610 be used to indicate it.
If the following services are provided, in addition to the services described in 93620, use code 93621 or 93622, respectively, on the claim:
* left atrial recording from the coronary sinus or the left atrium; and
* left ventricular recording and/or pacing.
93621 Comprehensive electrophysiologic evaluation with right atrial pacing and re- cording, right ventricular pacing and recording, HIS bundle recording, including inser- tion and repositioning of multiple electrode catheters; with left atrial recordings from coronary sinus or left atrium, with or without pacing
93622 with left ventricular recordings from, with or without pacing
The physician may elect to use intravenous agents diagnostically or therapeutically during a comprehensive EP evaluation with induction or attempted induction of arrhythmia (93620), left atrial recordings (93621) or left ventricular recordings (93622). This includes agents such as isoproterenol. When this occurs, assign code 93623 in addition to the appropriate code for the electrophysiolgic evaluation.
93623 Programmed stimulation and pacing after intravenous drug infusion (Use this code with 93620, 93621, 93622.)
Code 93624 is used to describe a follow-up electrophysiologic study to evaluate the efficacy of therapy undertaken subsequent to a baseline study. Do not use this code to indicate the reporting of generator evaluation when an EP study is not performed.
93624 Electrophysiologic follow-up study with pacing and recording to test effectiveness of therapy, including induction or attempted induction of arrhythmia
Pacing and Mapping
CPT code 93631 covers intraoperative epicardial and endocardial pacing and mapping. This service is used to localize tachycardia site(s) or zone(s) of slow conduction for surgical ablation. It may be performed alone or in conjunction with other surgical procedures. If performed during a surgical encounter for other procedures, the electrophysiologist should only code for his or her portion of the procedure.
93631 Intraoperative epicardial and endocardial pacing and mapping to localize the site of tachycardia or zone of slow conduction for surgical correction
Intracardiac Catheter Ablation
Codes 93650, 93651 and 93652 refer to intracardiac catheter ablation. Correct code assignment is based upon the ablation’s target site. Carefully read the operative report to determine this site, and look for clues, such as the type of arrhythmia for which the ablation is being performed (e.g., supraventricular tachycardia or ventricular tachycardia) or creation of a complete heart block.
Intracardiac catheter ablation is often performed at the same encounter as an EP evaluation. In these cases, assign the appropriate code for the service in addition to the ablation service.
Deborah C. Hall, a senior health care consultant with Medical Learning Inc. (MedLearn), St. Paul, MN, has more than 20 years of experience in physician management and reimbursement issues.