Coding From the Doctor's Note:
Eliminate EPS Errors With This Example
Published on Wed May 28, 2008
Your add-on codes must include documentationPractice your comprehensive electrophysiology study (EPS) coding skills by supplying codes for the following scenario adapted from an actual operative note.Our coding experts will show you what key phrases you should have highlighted and then take you step-by-step through picking the perfect EPS codes.First, Read This NoteProcedure: The patient arrived in the electrophysiology laboratory. All sheaths and catheters were inserted percutaneously using the Seldinger technique under conscious sedation with Propofol. The right clavicular region, right groin, and left groin were prepped and draped in the usual manner.The physician inserted a 4# French arterial sheath into the right femoral artery for monitoring blood pressure and arterial gases. The physician inserted a 7# French deflectable tip catheter into the right subclavian vein and advanced into the coronary sinus and great cardiac vein.The physician next inserted a 7# French deflectable tip catheter into the right femoral vein and positioned along the crista terminalis, with the tip of the catheter positioned at the ostium of the superior vena cava. He inserted a 7# French octapolar electrode catheter (2-mm spacing) into the left femoral vein and advanced it to the His bundle region. He inserted a 6# French hexapolar electrode catheter into the left femoral vein and advanced to the right atrial appendage. He next inserted a 7# French quadrapolar electrode catheter into the left femoral vein and advanced to the right ventricular base close to the His bundle for ventricular pacing.The physician used a 7.5# French deflectable quadrapolar catheter with a 4-mm irrigated tip electrode and location sensor for the EnSite 3D mapping system, which was inserted into the right femoral vein for right atrial mapping. The patient was awakened to allow induction of tachycardia. The physician induced five macroreentrant right atrial tachycardias. Afterward, he induced programmed atrial stimulation, AT#3, which had a cycle length of 345 msec.The report also contained appropriate measurements of the antegrade and retrograde atrioventricular nodal effective refractory periods, the A-H and H-V measurements, and details of both pacing and recording of the right atrium from the coronary sinus position.Pull Out Vital PhrasesWhen you're coding from a procedure note, you want to isolate key phrases.For instance, look at this statement: "The physician inserted a 4# French arterial sheath into the right femoral artery for monitoring blood pressure and arterial gases."Result: This statement supports billing code 36620 (Arterial catheterization or cannulation for sampling, monitoring, or transfusion [separate procedure]; percutaneous).Note: The last paragraph is critical. The physician's stating that he simply placed catheters in the appropriate positions does not make it a diagnostic study. The report must show the details of what the physician measured.Follow 4 Steps to Find Your EP CodesWhen you read the above note, [...]
