Anesthesia Coding Alert

Question: Our physician completed a charge ticket indicating implantable cardioverter defibrillator (ICD) testing during a cardiothoracic procedure. I thought 93742 would be the appropriate surgical code, but I didn't find a corresponding anesthesia code. What codes should I report?

Montana Subscriber Answer: Surgical codes that don't have corresponding anesthesia codes usually represent procedures that don't usually require anesthesia. First, check the operative report or talk with the anesthesiologist to learn why he conducted the test because that will point you in the right direction.

Likely, the physician reprogrammed the pump, based on your beginning point of 93742 (Electronic analysis of pacing cardioverter-defibrillator [includes interrogation, evaluation of pulse generator status, evaluation of programmable parameters at rest and during activity where applicable, using electrocardiographic recording and interpretation of recordings at rest and during exercise, analysis of event markers and device response]; single chamber or wearable cardioverter-defibrillator system, with reprogramming)
.
Take note: The best surgical code might be 93642 (Electrophysiologic evaluation of single or dual chamber pacing cardioverter-defibrillator [includes defibrillation threshold evaluation, introduction of arrhythmia, evaluation of sensing and pacing for arrhythmia termination, and programming or reprogramming of sensing or therapeutic parameters]) instead of 93742.

Here's why: Reporting 93642 means the physician induces an arrhythmia and the device shocks the patient (known as a non-invasive programmed stimulation test, or NIPS). The procedure requires anesthesia.

Coding caveat: Although your physician provided anesthesia during the ICD placement, you won't code for it this time. Anesthesia always reports the highest-level procedure during a session -- the cardiothoracic surgery in this case.

Future reference: If you code for the ICD placement with other patients, 93642 crosses to anesthesia code 00537 (Anesthesia for cardiac electrophysiologic procedures including radiofrequency ablation). Consider V53.31 (Cardiac pacemaker) for the diagnosis supporting the fitting or adjustment of a cardiac pacemaker.