# EP Study with Ablation and Cardioversion (help requested)



## dmd28 (Feb 25, 2010)

Hello,  Can anyone out there advise on this question I have.  Is it appropriate to code cardioversion at the same time as an EP Study with Ablation.  New to EP.  This is the coding I have. 

93620
93621
93651
93613
93623
92930-59

Also,  have a question about sequencing these codes since there are add on's etc...  Can anyone offer an opinion on this as well?

TIA
Dawn


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## Cyndi113 (Feb 25, 2010)

Dawn, please post your procedure note if possible. It helps to read the entire note.

Thanks,


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## dmd28 (Feb 26, 2010)

Hello Cynthia,  Here is the report.
Preprocedure Diagnosis: *Atrial Fibrillation, Dizziness
Procedures: **EP Study
Transeptal Puncture
Left Atrial Pacing and Recording
Electroanatomic Mapping (computer-assisted mapping)
Direct Current Cardioversion
Radiofrequency Ablation
Isoproterenol Infusion
Pulmonary Vein Isolation*

After informed consent was obtained , the patient was brought to the Cardiac Electrophysiology Laboratory in the fasting state and was prepped and draped in the usual sterile fashion. Both groins were infiltrated with 0.5% sensorcaine.

A 7 French duodecapolar catheter with a deflectable tip waS advanced via the left femoral vein was positioned with its distal tip in the coronary sinus and the body of the catheter along the lateral wall of the right femoral vein through an Agilis sheeth with toward the interatrial septum.  Transeptal puncture was performed And the sheeth was advanced into the left atrium.  Heparin was started to achieve adequate anticoagulation.  Aided by Endocardial Solutions Inc. Nav X three dimensional mapping system and an imported cardiac computed tomography of the left atrial anatomy, a 10 pole Lasso catheter was then used to create an anatomical map of the left atrium.

A 7 Fr EZ steer Bidirectional Celsius Thermacool irrigated tip ablation catheter with a 3.5mm tip was advanced through the Agilis sheeth with an 8.5mm internal diameter and positioned in the cavo-tricuspid isthmus.  Radiofrequency endergy was delivered.  Bidirectional block was confirmed using differential pacing. 

After the creation of the map, aided by Endocardial solutions Inc. Nav X three dimensional mapping system and direct fluroscopy, the ablation catheter was used to deliver circumferential lesions around the right and left pulmonary veins, as well as, a line along the left atrial roof between the encircling lesions and along the right and left carinas.  A second transeptal puncture was performed using a SL-1 sheath and another Brockenbrough needle.  A 10-pole Lasso catheter was positioned at the os of each pulmonary vein and the ablation catheter was positioned at the site of earliest pulmonary venous potential.  

Isuprel was infused, Atrial burst pacing was performed.  Direct current cardioversion was performed, after the procedure, Protamine was administered to partially reverse anticoagulation and all sheaths were removed: hemostatsis was achieved using manual comprssion.  The patient tolerated the procfure well without complication.

Thank You for your help
Dawn


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## RKN122306 (Mar 2, 2010)

code the 93651 its the most expensive because the second code usually gets reduced

93651
93620
93621
93613
93623
92960-59

Hope this helps


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