# EP Study and beating a dead horse



## eagomar (Aug 23, 2010)

I really hate to beat a dead horse, but I just need some clarification. What do you do when a physician clearly documents pacing and recording ONLY in the Right Atrium and the CS? Are we allowed to utilize the 52 modifier on the 93620 code so that we can bill 93621 or do I just use the RA pacing and recording codes and just not bill for the CS cannulation? I can't seem to find anything specific in writing and I know this has been addressed on the site but I've read both answers where you can use it and where you can't. Which one is correct? Thank you!


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## jwhassjr (Aug 23, 2010)

If the physician didn't document all of the elements of 93620, would it be reasonable to consider billing 93602 and 93610 instead? Not familiar with cardiac coding, but it doesn't seem appropriate to bill 93602 with modifier 52 if the physician only documented pacing and recording for the atria, and there are CPT codes which exist for those services.


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## eagomar (Aug 24, 2010)

The issue isn't billing for the right atrium codes - it's billing for the CS codes... We cannot bill a CS recording/pacing (93621) w/o the code 93620. The code 93620 is the recording and pacing of all 3 areas (RA, RV and HIS)....when only the right atrium is documented how do I bill for the CS? That is where my question lies - do I not bill the 93621 because all three areas were not addressed or do I bill the 93620 w/ a 52 modifer just so I can bill 93621? I know this has to be addressed w/ the physician but I wanted to know what people have done in the past..


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## mickara (Mar 23, 2012)

*RA recording LA (coronary sinus) recording only*

*I know this post is really old, but did you ever get a good answer in writing? I have the same scenario right now, and I'm not sure how to code it:*


1. Indications: xxxxxxx is a female with a history of SVT consistent with atrial flutter by ECG. She also has had an episode which appears more consistent with atrial fibrillation. These episodes have not been suppressed with antiarrhythmic drugs. She is undergoing electrophysiologic study and possible catheter ablation.



2. Procedures:

93609    intraventricular and/or intraatrial mapping of tachycardia sites with catheter manipulation          

              to record from multiple sites to identify origin of tachycardia



3. Details of Procedure: After signing informed consent the patient was brought to the McKay-Dee Heart Institute Electrophysiology Lab where under local anesthesia sheaths were placed in the right and left femoral veins. A small bore catheter was placed in the femoral artery to monitor arterial pressure. Multipolar electrode catheters were then positioned in the right atrium and coronary sinus. The patient was in SVT at baseline. The surface ECG was consistent with an atrial flutter*.Electrograms from the right atrium and left atrium from the coronary sinus were recorded during the baseline tachycardia. In the right atrium, the electrograms were organized with activation from the superior lateral RA inferiorly toward the cavotricuspid isthmus in a counterclockwise pattern. In the coronary sinus, the electrograms were fractionated with a varying pattern of left atrial and CS activation sequences. With continual recording along the lateral RA, the activation sequence was noted to vary*. These findings were consistent with fibrillation in the left atrium and irregular activation to the right atrium[/B][/B][/B]. There was no consistent activation sequence of intracardiac electrograms in the right atrium or coronary sinus. The catheters and sheaths were then removed and hemostasis maintained by pressure over the insertion sites. The patient was returned to the floor with no complications.


4. Summary: Based on the intracardiac electrogram maps, the patient is in atrial fibrillation and not atrial flutter or tachycardia. No ablation was performed.


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