# EPS help



## kdoughty (May 21, 2012)

Does anyone know what else I can bill for this other than the 93650 and 93613.  Thanks!


EPS: Bundle of HIS recording

EPS: Cardiac Mapping (3-D Computer Assisted)
Ablation: Intra Cardiac - SVT ,AV node complete
INDICATIONS FOR PROCEDURES: Arrhythmia: Atrial Fibrillation
DIAGNOSIS: Atrial Fib
Successful Ablation
Access site:
Sheath(s):
Venous access: 8 Fr. short sheath inserted into Rt femoral vein.
PROCEDURE:  Following fully informed consent, the patient was brought to the
Electrophysiology laboratory in a fasting, non-sedated state.  The groin was
prepped in the usual fashion.  2% Lidocaine was used for local anesthesia. 
Using the Seldinger technique, the introducer and sheath were placed into the
appropriate access site.
Multipolar electrode catheters were positioned in the appropriate cardiac
chambers under fluoroscopic guidance.  The catheters were placed in the right
atrium
RV Apex
HIS bundle.
Pacing Protocols:
Locations paced:
Right Atrium, RV Apex
Pacing Techniques:
Ventricular ExtraStimulation
Following completion of the stimulation protocols, the catheters were removed,
the introducer sheaths were removed, and appropriate pressure was applied to
obtain complete hemostasis.
BASELINE EPS
Baseline Rhythm:
Atrial Fibrillation with VR=82
Basic Intervals:
HV=42ms
Sinus Node Function:
Abnormal
Atrial Pacing:
AF
Ventricular Pacing:
VERP 250ms @ 350 and 400ms DCL
POST ABLATION:
BASIC INTERVALS:
Paced
SINUS NODE FUNCTION:
Paced
ATRIAL PACING:
not assessed
VENTRICULAR PACING:
Paced at VVIR 80
:
CONCLUSIONS:
* Atrial Fib
* Successful Ablation
RECOMMENDATIONS:
1. Resume Warfarin in 2 days
2. Device programmed to VVIR 80 for 6 weeks
3. Wound check in 1 week
4. Follow up in Pacer clinic in 6 weeks for reprogramming 
ADDITIONAL COMMENTS:
At baseline AF
Frequent PVCs with origin from epicardial LVOT
Normal His Purkinje function
Ablation catheter placed in location of compact AV node
RF energy delivered with accelerated junctional rhythm
Complete AV block noted with ventricular escape
Device programmed to VVIR 80-130


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## dpeoples (May 21, 2012)

klallier said:


> Does anyone know what else I can bill for this other than the 93650 and 93613.  Thanks!
> 
> 
> EPS: Bundle of HIS recording
> ...



Unless it has changed in the last year, this procedure (93650) includes the EP study, mapping (93613/93609), drug infusion and the actual ablation.  

HTH


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## rpcarrillo (May 21, 2012)

Yeah I agree, the type of EP studies and mappings performed during these AV node ablations are quite abbreviated and are considered bundled into the code for the ablation, 93650.

From your report it seems that there was a cardiac rhythm device already in place and not implanted during this same operative session, and it was reprogrammed at the conclusion of the procedure, so depending on whether it was a pacemaker or defibrillator you may be able to code additionally for 93286 or 93287.

93286/93287 may be also included in spirit in the ablation because if you're destroying the heart's natural pacemaker it would logically follow that you'd also need to reprogram any device already in place to take the increased pacing duty. But 93286 and 93650 don't seem to be bundled in NCCI and I can't find a mention of this particular scenario in my Dr. Z reference book, so my opinion would be to go ahead and code the 93286/93287 and 93650 together.


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## kdoughty (May 22, 2012)

Thanks!


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