# CRM Code 93282 during a EP Study



## jtuominen (Jun 2, 2009)

Hi All--

Wondering if anyone has investigated the documentation requirements for the new Cardiac Rhythm Management codes? lately the cath lab here has been entering charges for them during EP Studies, and I feel shaky about the documentation support. What do you think about this one? Here is the Codeset I am thinking of:
93620
93621
93623
93282 (? unsure of documentation giving me enough to assign this.)

Also, Im not planning on charging for the external cardioversion (92960) since primary diagnosis is VT and not afib. Do you agree?

PROCEDURES PERFORMED: 
1.  Comprehensive EP study with left atrial recording through the 
coronary sinus. 
2.  Repeat EP study with isoproterenol infusion. 
3.  ICD reprogramming. 

INDICATIONS FOR THE PROCEDURE:  69-year-old white male 
with a history of coronary artery disease and ventricular tachycardia 
status post ICD implant.  He is on amiodarone for recurrent VT.  The 
ICD interrogation showed slow VT of 170 bpm that was not treated.  
The known QRS morphology could not be used to exclude SVT.  Due to 
the nondetection of the arrhythmia and the relatively fast rate, it 
was decided to perform an EP study to rule out any slow VT or rapid 
SVT. 

PROCEDURE AND RESULTS:  After the written informed consent was 
obtained the patient was transported to CV Lab #4 in the fasting 
state.  The procedure was performed under local anesthesia and 
sterile conditions.  Intravenous Versed and fentanyl were used for 
conscious sedation.  The ICD was programmed without VT/VF detection.  
By using the Seldinger technique, *a 5 French decapolar catheter was 
inserted through the right internal jugular vein and was positioned 
into the coronary sinus.* (93621)  *Three quadripolar catheters were inserted 
through the right femoral vein and were positioned into the high 
right atrium, the His bundle region, and the RV apex. 
* (93620)
The patient was in normal sinus rhythm.  The A-H and H-V intervals 
were normal.  Ventricular stimulation at the baseline did not show 
any V-A conduction.  The antegrade A-V node conduction was relatively 
poor, with A-V Wenckebach cycle length of about 560 milliseconds.  He 
clearly had A-H block within the A-V node. 

Programmed ventricular extrastimulation induced sustained monomorphic 
rapid VT with double extrastimuli.  The coupling intervals of 
induction were 400/260/240 milliseconds.  The VT had a rate of 215 
bpm with superior axis and right bundle-branch block.  *The VT was not 
pace-terminable, and the patient lost consciousness before DC 
cardioversion. *  (not going to code 92960 since diagnosis is not afib)

*After the DC cardioversion of VT the patient was given isoproterenol 
infusion of 2 mcg/min.  During isoproterenol infusion repeat 
ventricular stimulation showed the appearance of retrograde V-A 
conduction through the normal His-Purkinje system. * (93623) However, the V-A 
conduction was still relatively poor and ventricular extrastimulation 
with single extrastimuli did not induce SVT.  Subsequently, atrial 
extrastimulation was performed by using double and triple 
extrastimuli.  There was no inducible SVT. 

*Due to the lack of inducible clinically-relevant tachyarrhythmia, it 
was decided not to pursue ablation of the rapid VT.*  The catheters 
and sheaths were removed and local pressure was applied to the 
puncture sites.  There was no complication. 

The patient will continue amiodarone.  *The ICD has been reprogrammed 
with the VT detection rate reduced from 170 bpm to 160 bpm. * (93282???)


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## deeva456 (Jun 4, 2009)

Hey there,

I agree with your code set. I would bill for the cardioversion. Since the pt lost consciousness it was medically necessary to perform the cardioversion and this is clearly supported in the report.   I agree with you about 93282, not enough info provided. It seems like there should be something more documented. The doc doesn't indicate that he went through the adjustments Can you have the doc do an addendum?  

Dolores, CPC, CCC


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