# 93524 with 93620 and 93651



## jtuominen (Mar 9, 2009)

Hi there--

It is appropriate to bill 93524 with a 59 modifier for a transeptal puncture performed in order to advance a catheter for an EP study and ablation          (93620/93651) when the dictation did not support that anything was out of the ordinary or that there was a distinct reason why the doctor elected to do the transseptal puncture in order to complete the EP study? Wondering what others may do in this siutation since there is a CCI edit when 93524 is billed with 93620 and 93651.


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## deeva456 (Mar 9, 2009)

No, you cannot bill 93524-59 with 93620 & 93650. If the doctor is doing a transeptal puncture to access the left atrium or left ventricle add modifier 22 to 93650.  Unfortunately there isn't a separate code for the transeptal punture.  to bill 93524 with the EP study and ablation, you must indicate medical necessity to bill this code and your documentation has to support billing the heart cath. A few months ago, CMS issued a new LCD list for 93524

I hope this answers your question.

Dee


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## jtuominen (Mar 10, 2009)

Dee- thanks so much. I think I was able to find the LCD that you may have been disucussing--L10880 (from WPS for IL). So would then is it safe to say that under normal circumstances, there would not be a case for 93524 with 93620? Ive got to explain this someone with a limited knowledge of coding guidelines.


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## jtuominen (Mar 10, 2009)

Have still been chewing this one all morning--and just in follow up in case anyone else is looking at this thread--among other reasons, I also realized that billing 93620 and 93524 under normal cirucmstances may not be correct either based on the fact that you would be coding the catheter placement in the right atrium twice.

93524 catheter placement in the left ventricle and right atrium
93620 catheter placement in the right atium, bundle of His, and right ventricle

Thanks so much Dee!


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## deeva456 (Mar 10, 2009)

Yes, you are correct; under normal billing circumstances you would not bill 93524 with 93620 since the catheter is already placed in the right atrium for the EP study.  I have researched this same subject for over a year now. We have an MD who insists he could bill these two codes together... but after much reseach and speaking with a consultant, he was finally convinced that 93650-22 is the correct way to bill the ablation with a transeptal puncture.  I havent seen any cases where it was necessary to do the 93524 & 93620, 93650 at the same session, not that is hasn't occurred, I just havent come across a case like that. 

Good luck!

Dee


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## jtuominen (Apr 14, 2009)

I hate to beat this subject yet again...


But my cath lab continues to wonder why transseptal puncture during an EP study cannot be billed as 93620 and 93524. 

Aside from the CCI edit issues, and the LCD on 93524 that I read and cited, I was wondering if there is anyone out there that is billing these two codes together?  Under what circumstances if so? They insist previous coders that have worked with them always billed this together.


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## jtuominen (Apr 16, 2009)

*Answer from MedLearn*

I finally posed my question to MedLearn and got an official response:

Here is their response on whether it is appropriate to bill a 93524 (or a 93527 for that matter) with a comprehensive EP Study:

Medicare has issued an edit that prohibits the billing of code 93524 and 93527 with EP and ablation studies. This edit was issued by Medicare because their review of physician's dictated report did not justify the code because full and complete right and left heart catheterization were performed. 

The Heart Rhythm Society states that they do not recommend billing code
93524 or 93527 with EP or Ablation procedures unless all of the elements of a full and complete heart catheterization is performed. Full and complete means that all of the elements performed in a non-related EP or ablation catheterization are met. For example when a right heart catheterization is performed multiple pressure measurements are obtained in multiple areas of the right heart and pulmonary arteries. When a left heart is performed LVEDP is performed. It is rare that the same elements or pressure measurements are obtained during a EP or Ablation procedure that required transeptal approach.

Reference relating to this are the HRS coding manual and MedLearn's CRM coder.


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