# Can anybody help on This EP study



## vikas.maheshwari (Feb 8, 2010)

The Rt. femoral artery was entered percutaneously and cannulated with a 5 Fr. introducer sheaths using a modified Seldinger technique. 6 Fr. Cournand EP diagnostic catheter was 
introduced through the 6 Fr. sheath and advanced into HIS bundle position.
6 Fr. Dynamic decca EP diagnostic catheter was introduced through the 7 Fr. sheath and advanced into coronary sinus. 7 Fr. Du0-decca EP mapping catheter was introduced 
into the sheath into the ra. After diagnostic catheters were introduced, 
baseline measurements were recorded. The 8 Fr. short sheath was exchanged for an 8.5 Fr.
Agilis long sheath. 8 Fr. EPT 8MM ablation catheter was introduced 
through the 8 Fr. sheath and advanced into the RA. With the ablation catheter, mapping was performed with good signals. 5 Fr. Pigtail catheter was inserted into RFA and 
advanced to aortic root over the glide wire and  biplane aortography was perfomed with 15 mL of  contrast and images were obtained and roadmapped. An 18 gauge X 98 cm Brockenbrough transseptal needle was introduced into the Agilis long sheath. Using fluoroscopic landmarks and pressures in the right atrium, and using aortic root roadmaps, the ostium of the fossa ovalis and puncured the septum. The pressures of the left atrium were measured and the sheath was advanced into the left atrium for first transseptal access. The 8 Fr. short sheath was exchanged for an 8 Fr. Prefface long sheath. An 18 gauge X 71 cm Brockenbrough transseptal needle was introduced into the Using identical technique, the second transseptal puncture was performed and access was obtained without complications. 7 Fr. Lasso EP mapping catheter was introduced into the sheath into the la. 8 Fr. Thermocool D & F curve ablation catheter was introduced through the 8,5 Fr. sheath and  advanced into the la.
Biplane contrast venography was perfomed of the pulmonary veins and the left atrim and images were obtained and roadmapped to assist with mapping. Using the roadmaps, a three-dimensional anatomic  map was contructed of the left atrium and pulmonary veins.

I have coded this with 
93651
93527-26-59
93600-26-59
93602-26-59
93613
93544-59
93556-26-59


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## deeva456 (Feb 8, 2010)

Hello,

I would be more than happy to help you code this report. Our EP left our practice so I haven't had any EP reports to read; I'm afraid if I dont use it, I'll lose it...anywaay here are your codes and explanation.

93651-22
93600-26-59
93602-26-59
93613

I would not code 93527, 93544 or 93556-2659 because it appears the doctor was doing this for "road mapping" and placement only"  Unless it was medically necessary to perform the heart cath then yes you could bill it; but you will also need an acceptable dx for the heart cath.  Unfortunately transseptal punctures do not have thier own separate code, therefore you would add modifer 22 to 93651. It  would help if the doctor had dictated how much time he spent doing the puncture compared to doing an ablation w/o the puncture.  I hope this makes sense and if you have more questions just drop me a line.

Dolores, CCC-CPC


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## vikas.maheshwari (Feb 9, 2010)

I really appreciate your help. Did you have some sample reports with CPT codes for different scenario for my future response If yes please mail me at vikashmaheshwari@gmail.com

Thanks again for your help


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