# Posting Report for Electrophysiology w/Ablation and Cardioversion



## dmd28 (Feb 26, 2010)

Hello,  Here is the report, per previouse Thread, I am inquiring on if a Cardioversion can be billed in the same session as a EP Study w/Ablation.  And also inquiring about sequencing of the codes, with the add on codes. 

93620
93621
93651
93613
93623
92960-59

Preprocedure Diagnosis: Atrial Fibrillation, Dizziness (432.31) (780.4)
Procedures: EP Study
Transeptal Puncture
Left Atrial Pacing and Recording
Electroanatomic Mapping (computer-assisted mapping)
Direct Current Cardioversion
Radiofrequency Ablation
Isoproterenol Infusion
Pulmonary Vein Isolation

After informed consent was obtained , the patient was brought to the Cardiac Electrophysiology Laboratory in the fasting state and was prepped and draped in the usual sterile fashion. Both groins were infiltrated with 0.5% sensorcaine.

A 7 French duodecapolar catheter with a deflectable tip waS advanced via the left femoral vein was positioned with its distal tip in the coronary sinus and the body of the catheter along the lateral wall of the right femoral vein through an Agilis sheeth with toward the interatrial septum. Transeptal puncture was performed And the sheeth was advanced into the left atrium. Heparin was started to achieve adequate anticoagulation. Aided by Endocardial Solutions Inc. Nav X three dimensional mapping system and an imported cardiac computed tomography of the left atrial anatomy, a 10 pole Lasso catheter was then used to create an anatomical map of the left atrium.

A 7 Fr EZ steer Bidirectional Celsius Thermacool irrigated tip ablation catheter with a 3.5mm tip was advanced through the Agilis sheeth with an 8.5mm internal diameter and positioned in the cavo-tricuspid isthmus. Radiofrequency endergy was delivered. Bidirectional block was confirmed using differential pacing. 

After the creation of the map, aided by Endocardial solutions Inc. Nav X three dimensional mapping system and direct fluroscopy, the ablation catheter was used to deliver circumferential lesions around the right and left pulmonary veins, as well as, a line along the left atrial roof between the encircling lesions and along the right and left carinas. A second transeptal puncture was performed using a SL-1 sheath and another Brockenbrough needle. A 10-pole Lasso catheter was positioned at the os of each pulmonary vein and the ablation catheter was positioned at the site of earliest pulmonary venous potential. 

Isuprel was infused, Atrial burst pacing was performed. Direct current cardioversion was performed, after the procedure, Protamine was administered to partially reverse anticoagulation and all sheaths were removed: hemostatsis was achieved using manual comprssion. The patient tolerated the procfure well without complication.

Thank You for your help
Dawn


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## jtuominen (Mar 16, 2010)

Hi Dawn-- Cardioversions should not be billed for when performed during the course of an EP stud. The only time you can bill a cardioversion is if they cardiovert the patient prior to the start of the EP study.

Jayna RHIA, CIRCC


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## coding?4u (Apr 5, 2010)

*Cardioversion during EP*

I am billing as well with the 59 modifier for external CV.  I dont see the back end; therefore, I have no experience if denied.  Can you tell me where I can find this information that states not to bill?  I need to have something to use in changing my practice of billing these.  Thanks so much.


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## jtuominen (Apr 9, 2010)

There are two great books published by MedLearn that can give you the background on billing cardioversions-- The Cardiac Rhythm Management Coder and another book called the Peripheral and Cardiology Coder. They are a little spendy but I use them all the time. They are a great srouces. There is also a CPT Assistant, June 2000 Pages: 5-6 Category: Coding Communication that instructs to not seperately report cardioversions with the EP study codes.


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## coding?4u (Apr 15, 2010)

Thanks so much for responding.


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## coding?4u (Apr 15, 2010)

It's me again!

I referenced 3 articles in CPT Assistant-I could not find exactly what you stated above, this is the best I could find.  Am I in the right place?


Internal Cardioversion (Code 92961) 

Code 92960 describes external cardioversion only. Therefore, a new code 92961 has been added to describe intracardiac cardioversion, an effective therapy for patients unresponsive to external cardioversion. Code 92960 has been revised to a parent code format by the addition of a semicolon to accommodate placement of a new indented procedure describing “internal” elective electrical cardioversion. 

Because cardioversion is commonly necessary during electrophysiologic procedures. In these instances, cardioversion is considered an inclusive component not warranting additional reporting. It is not appropriate to report code 92961 in addition to the electrophysiology procedures 93618-93624, 93631, 93640-93642, 93650-93652 or 93741-93744.


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## jtuominen (Apr 20, 2010)

Hi again--

I see that now that the CPT Assistant doesn't clearly delinate those coding rules for 92960 as it does for 92961. But instead you may find this resource useful. This is a link to the consulting company website I mentioned earlier (medlearn). They have a free weekly Q&A email they can send to you if you sign up regarding Cardiac Cath coding issues. This link takes you to their archive of questions. Check out the Q&A on Jan 18, 2010, Feb 8, 2010
for inforamtion on cardioversions.

http://www.medlearn.com/questions/cardiology_arch.html


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## coding?4u (May 12, 2010)

Thank you so much for following this.  I will certainly take what information 
you have provided and put it to good use.

Cathy


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