# +93623 w/out Ablation



## KoBee (Jul 25, 2019)

So my first time running into this scenario and not really sure how to bill for it or if possible.

I have a provider who billed 93623 by itself, provider mentioned he brought the patient for an ablation but NEVER performed the procedure since there was no inducible abnormal rhythm at the time, he only gave patient Isuprel to try to induce the rhythm 

Is this billable ? help please! :/


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## cpc2007 (Jul 30, 2019)

It's tough to tell from the limited information, but did your physician perform an electrophysiologic study (93619 or 93620)? These codes also serve as valid primary codes for add on 93623 and include "induction or arrhythmia" or "attempted induction of arrhythmia" (which is essentially what happened here). If the physician documented other details to support one of these codes (placement of catheters with pacing and recording from the sites required), I would pair either 93619 or 93620 with 93623. If he truly only performed the 93623 and then terminated which would be rare, you could consider an unlisted code instead since the add on won't be paid without a valid primary CPT.

I hope that helps -have a good night!

Kim
www.codingmastery.com


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## KoBee (Aug 1, 2019)

cpc2007 said:


> It's tough to tell from the limited information, but did your physician perform an electrophysiologic study (93619 or 93620)? These codes also serve as valid primary codes for add on 93623 and include "induction or arrhythmia" or "attempted induction of arrhythmia" (which is essentially what happened here). If the physician documented other details to support one of these codes (placement of catheters with pacing and recording from the sites required), I would pair either 93619 or 93620 with 93623. If he truly only performed the 93623 and then terminated which would be rare, you could consider an unlisted code instead since the add on won't be paid without a valid primary CPT.
> 
> I hope that helps -have a good night!
> 
> ...


This is the providers note: hope this helps

PROCEDURE PERFORMED:
Programmed stimulation and pacing after IV drug infusion isoproterenol.

PREOPERATIVE DIAGNOSIS:
Premature ventricular contraction.

POSTOPERATIVE DIAGNOSIS:
Premature ventricular contraction.

COMPLICATIONS:
None.

SPECIMEN TAKEN:
None.

ESTIMATED BLOOD LOSS:
Zero.

CONTRAST:
Zero.

SEDATION:
None.

BRIEF SYNOPSIS:
Mr. xxx is a 76-year-old gentleman with past medical history of
coronary artery disease, prior bypass, first-degree AV block, ischemic
cardiomyopathy, congestive heart failure, Medtronic dual-chamber ICD. He was
noted on outpatient Holter monitor to have 30% PVC burden. He is seen,
examined and deemed appropriate for EP study and PVC ablation.

DESCRIPTION OF PROCEDURE:
The patient was brought to the EP lab in a fasting state, whereupon he was
connected to blood pressure, pulse oximetry and electrocardiographic
monitoring. He presented in sinus rhythm. At baseline, he had complete
suppression of his PVCs.

Sinus cycle length was 1200 milliseconds, PR 186, QRS 118, QT 460.

He had a single PVC, which carried a right bundle-branch morphology and
transition between leads V5 and V6. The access was superior and it was
positive in lead 1, AVR and aVL.

I then initiated isoproterenol up to 30 mcg. On isoproterenol, sinus cycle
length was 1000 milliseconds, PR 179, QRS 125, QT 440. During Isuprel, there
were no inducible PVCs. Following the washout phase of Isuprel, there was
another PVC, however, PVC #2 carried a different morphology. It had a right
bundle morphology and transition at V5. The access was inferior and negative
in lead 1 and aVL. It was biphasic in lead aVR.

Due to the paucity of PVCs as well as his inability to be induced with
isoproterenol, we decided not to pursue ablation.


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## cpc2007 (Aug 7, 2019)

michiboo said:


> This is the providers note: hope this helps
> 
> PROCEDURE PERFORMED:
> Programmed stimulation and pacing after IV drug infusion isoproterenol.
> ...





michiboo said:


> This is the providers note: hope this helps
> 
> PROCEDURE PERFORMED:
> Programmed stimulation and pacing after IV drug infusion isoproterenol.
> ...



Thank you for sharing the physician's note. So in this case, the patient was brought to the EP lab, but instead of doing an invasive EP study (where they insert catheters and induce or attempt to induce arrhythmias from within the heart), the physician is monitoring the patient with external devices including pulse oximetry and electrocardiographic monitoring while giving the Isoproterenol through an IV. Therefore, the findings here about sinus cycle length and the rare PVCs are being obtained with EKG monitoring from outside the body. Since you don't have documentation to support an EP study code (93619 or 93620), you won't be able to report 93623 since it is an add on code and, you don't have a valid primary CPT. I would suggest reporting 93799 (unlisted). Dr. Z of Z Health Publishing who is a well-respected interventional and cardiology consultant gave similar advise for a scenario where a patient had a Procainamide challenge to try to re-induce an arrhythmia found on a prior EKG without an invasive EP study. 

I hope the additional advice is helpful - have a great night!

Kim


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## KoBee (Aug 8, 2019)

cpc2007 said:


> Thank you for sharing the physician's note. So in this case, the patient was brought to the EP lab, but instead of doing an invasive EP study (where they insert catheters and induce or attempt to induce arrhythmias from within the heart), the physician is monitoring the patient with external devices including pulse oximetry and electrocardiographic monitoring while giving the Isoproterenol through an IV. Therefore, the findings here about sinus cycle length and the rare PVCs are being obtained with EKG monitoring from outside the body. Since you don't have documentation to support an EP study code (93619 or 93620), you won't be able to report 93623 since it is an add on code and, you don't have a valid primary CPT. I would suggest reporting 93799 (unlisted). Dr. Z of Z Health Publishing who is a well-respected interventional and cardiology consultant gave similar advise for a scenario where a patient had a Procainamide challenge to try to re-induce an arrhythmia found on a prior EKG without an invasive EP study.
> 
> I hope the additional advice is helpful - have a great night!
> 
> Kim


Thank you so much for the response, makes a lot more sense. If I were to use 93799, not sure what code would be comparable to in order for the dollar amount. Any suggestions?


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## cpc2007 (Aug 8, 2019)

You're welcome! I think I would compare the 93799 back to the 93623. The 93623 describes injecting a drug like Isoproterenol through an IV which is what your physician did. He just happened to not do this during an invasive EP study so there's no primary code, making us go to the unlisted. But I think the work of what he did is on par with the 93623. Another option is to let your physician help with pricing the unlisted if you have an opportunity to do that (I will do that sometimes since no one knows better the work involved in the procedure than the physician). 

I hope that helps 

Kim
www.codingmastery.com


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## scuatro4 (Apr 8, 2020)

Hello, I am starting to study on my cardiology coding as well, and I have come across this procedure. and found that the wording in CPT book states " ...with induction or *attempted *induction..." which means even if it was not successful the provider may still report primary procedure. Along with add on code if done.


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