# Help Please - premature ventricular



## karenk123 (Sep 10, 2010)

What would you code? Thanks

PROCEDURE:  Isuprel challenge. 

PRE-PROCEDURE DIAGNOSIS:  Symptomatic premature ventricular 
contractions. 

The patient was referred for a potential EP study and ablation should she 
have an increased amount of premature ventricular contractions. 
DESCRIPTION OF PROCEDURE:  The patient was observed on the table with 
a  
12-lead EKG.  She had a few premature ventricular contractions 
consistent with a left bundle branch inferior axis with the 
transition in lead V3 and no subsequent premature ventricular 
contractions.  Therefore Isuprel was given up to 10 mcg/minute.  
During Isuprel infusion and washout the patient had several different 
types of premature ventricular contraction morphology, but none of 
these appeared to be clinical. 

PLAN:  Given the above findings there is no need to continue with the 
procedure.  The best hope will be pace mapping.  However, even this 
treatment will yield only a  
50% success rate.  The clinical premature ventricular contraction 
appears on the left side, and therefore the risks of continuing the 
procedure probably outweigh the benefits.  We decided not to proceed. 

CONCLUSION:  There were a few isolated premature ventricular 
contractions noted before starting the case.  Despite the high dose 
of Isuprel infusion and with exercise the patient s premature 
ventricular contraction burden did not increase.  Therefore there did 
not appear to be a need to proceed with the procedure.  The patient 
will be prescribed a trial of Verapamil 120 mg a day.


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## theresa.dix@tennova.com (Sep 15, 2010)

*drug challenge*

There has been confusion over this senario. Not a clear cut answer but here are a couple of options. 

  A patient was prepped for an EP study and a 12-lead study showed (whatever) the decision was made to give IV isoprel. There are two coding options: Report the infusion,  or use code 93620 with a discontinued modifier (53/73). 

These are the only two ways i know to report this case. I would be interested to know how other coders would report this.

Thanks!


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## jtuominen (Sep 16, 2010)

I don't have any documentation on this-- but what about a 12 Lead EKG code 93005/93010 and what about an infusion code? 96365 maybe?

96365 Intravenous infusion, for therapy, prophylaxis, or diagnosis (specify substance or drug); initial, up to 1 hour


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## karenk123 (Sep 21, 2010)

Thanks no. 1


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