# Comprehensive V. Single Site EP Study Codes



## jtuominen (Jul 30, 2009)

I was in a webinar today and the host discussed the appropriate indicators necessary to code 93620 vs. the component codes for an EP study. I left feeling a bit confused because I wrote down that I had thought they had stated the documentation of A-H and H-V interval values is sufficient all on its own in order to bill the comprehensive EP study code 93620, even if the doctor states catheter placement only in the atrium and CS, and even if the doctor only discusses burst atrial pacing and recording.  So, based on that piece of information, I posed the following dictation for discussion to them, I am wondering also how others may interpret the correct coding of this case as well. Give it and read and let me know what you think. Thanks!

PROCEDURES PERFORMED:  EP study and ablation.

INDICATION:  Atrial flutter.

HISTORY OF PRESENT ILLNESS:  This is a delightful 65-year-old 
gentleman with a history of coronary artery disease and mitral valve 
repair and had a history of postoperative atrial fibrillation.  
Recently he was noted to be in a wide complex tachycardia with a 
right bundle-branch block identical to his baseline morphology.  It 
appears to be typical atrial flutter based on the morphology of the 
flutter waves.  Due to the severity of symptoms he underwent a 
cardioversion one week ago.  Given the likelihood that it will recur 
again, the patient was referred for EP study and ablation.

METHOD:  After obtaining informed consent, the patient was prepped 
and draped in the usual fashion.  Conscious sedation was 
administered.  One-percent lidocaine was infiltrated into the right 
femoral area.  6, 7, and 8 French sheaths were then placed in the 
right femoral vein via the Seldinger technique.  A deflectable 
decapolar catheter was placed in the CS and a duodecapolar catheter 
was placed around the TV annulus.  Burst atrial pacing was then 
performed.  Additionally, atrial extrastimuli up to triples were then 
performed.

Although no SVT was inducible, based upon the morphology of the 
patient's clinical tachycardia it was decided to ablate the 
cavotricuspid isthmus.  Therefore an 8 mm ablation catheter was then 
advanced into the RA.  Ablation was then performed using EPT 
generator.

Post ablation, burst atrial pacing was then performed.  Additionally, 
atrial extrastimuli up to triples were then repeated at baseline and 
with 2 mcg of Isuprel.  At the conclusion of the study catheters and 
sheaths were then removed.  Hemostasis was achieved by direct manual 
pressure.  The patient was then transferred back to the Care Suites 
in stable condition.

CONDUCTION INTERVALS: 
1.  P-R 187, AH 91, H-V 46.
2.  A-V nodal Wenckebach was 370, A-V nodal ERP was 600/260.

ABLATION SUMMARY:  Four applications of radiofrequency ablation were 
targeted at the cavotricuspid isthmus at 70 watts and 60 degrees 
Celsius for 120 seconds.   Bidirectional block was demonstrated and 
was still present at 30 minutes post ablation.

COMPLICATIONS:  None.


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## andersee (Aug 6, 2009)

According to Coding Strategies, Z-health and CPT Assist, if two catheters are placed in 2 of the 3 areas (RA, RV, His), a comprehensive code may be billed with a modifier 52. If 3 catheters are placed in all three areas, a comp code without a 52 may be billed. I still like to see that some pacing and recording are done in at least one area and would be inclined to bill the component codes if 2 caths were placed but no pacing done at all. 

In the case you described, I would go back to the MD to clarify what he did to see if the documentation is missing something. Based on the documentation, I would bill the component codes.

Can you tell me what company put on the seminar? 

Erin


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## deeva456 (Aug 7, 2009)

Hi 

After reading your post, I reviewed the webinar you are referring too.  I read the report and agree with you, to bill 93620. Based on the report, I would bill with the following codes


93620- catheters placed in the atrium & CS.
93623 - use of isupril is indicated. 
93651 - ablation for treatment of atrial flutter, fibrillation. 

recording and pacing of the left ventricle is not indicated so you cannot bill 93621. 

I hope this helps.

Dolores, CPC - CCC


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