Bill Left-chamber EP With Multiple Studies Only
Published on Tue May 01, 2001
When performing a multiple-catheter electrophysiology (EP) study including left atrial or left ventricular recording, CPT coding principles and the national Correct Coding Initiative (CCI) specify that only one complete study should be billed. However, several authoritative sources offer conflicting coding advice. As a result, CPT 2002 is expected to revise how these procedures are coded and billed. In late April, representatives from the American College of Cardiology (ACC) and the North American Society of Pacing and Electrophysiology (NASPE) met with the AMAs Relative Value Update Committee to address the proposed changes and determine how the revamped codes should be valued. Any changes (which have yet to be officially announced) would not take effect at least until Jan. 1, 2002. Until then, the billing of EP studies should be governed by the wording of the code descriptors in CPT and bundling guidelines in the CCI unless otherwise indicated (in writing) by the carrier. CPT 2001 lists four EP study codes: 93619 comprehensive electrophysiologic evaluation with right atrial pacing and recording, right ventricular pacing and recording, His bundle recording, including insertion and repositioning of multiple electrode catheters; without induction or attempted induction of arrhythmia [this code is to be used when 93600 is combined with 93602, 93603, 93610, 93612); 12.25 relative value units (RVUs);
93620 with induction or attempted induction of arrhythmia (this code is to be used when 93618 is combined with 93619); 19.41 RVUs; 93621 with left atrial recordings from coronary sinus or left atrium, with or without pacing, with induction or attempted induction of arrhythmia; 21.20 RVUs; and 93622 with left ventricular recordings, with or without pacing, with induction or attempted induction of arrhythmia; 21.32 RVUs. Note: The RVUs associated with each code above represent the facility fee. Modifier -26 (professional component) should be attached to any of these procedures when performed in the hospital. Billing Issues These codes are sequential, with the second code building on the first, and so on (with one important exception: See Note below). For example, says Rebecca Sanzone, CPC, billing manager with Mid-Atlantic Cardiovascular Associates, a 47-cardiologist practice in Baltimore, 93620 includes all the elements of 93619 but also includes induction or attempted induction of arrhythmia. Similarly, 93621 includes 93620 but adds left atrial recordings from the coronary sinus or left atrium. Note: Code 93622, which includes left ventricular recordings, does not also include left atrial recordings, and therefore does not follow in sequence from 93621. However, like 93621, it includes 93620. Several factors complicate the billing of EP studies. First, the additional reimbursement for 93621 and 93622 (1.79 and 1.91 RVUs, respectively) does not adequately compensate for the additional work of obtaining recordings [...]
