93622 with induction or attempted induction of arrhythmia; with left ventricular pacing and recording (list separately in addition to code for primary procedure).
The most significant change is the "add-on" status accorded 93621 and 93622. CPT should be able to eliminate a major source of coding and billing confusion in making these add-on codes.
Electrophysiologists who perform left atrial or ventricular pacing and recording in conjunction with a comprehensive EP exam have difficulty obtaining reimbursement for the additional left-side study. As of CPT 2001, 93621 and 93622 are valued at little more than 93620, so electrophysiologists who perform left atrial or ventricular studies are not reimbursed fairly for the additional work involved.
The response to this unfair situation was a series of conflicting and sometimes erroneous coding instructions from authoritative publications and organizations. For instance, electrophysiologists have been instructed to bill 93620 separately from 93621 or 93622, in spite of the fact that 93621/93622 includes all the components of 93620 other than the additional left-side study and even though 93622 and 93621 both include 93620 in the national Correct Coding Initiative (for more on this issue, see Cardiology Coding Alert, Vol. 4, No. 5, May 2001).
CPT has gone some way toward resolving this difficult issue. By making 93621 and 93622 add-on codes, CPT is instructing EP physicians to bill for the right-side EP using 93620 (if induction of arrhythmia was achieved or attempted) and 93621 or 93622 for additional left atrial or ventricular pacing, respectively.
Although this may clarify the coding for some, it is important to note that the core of this problem did not involve the coding as much as the payment. For instance, it is correct to bill 93622 only if a left ventricular study was performed in conjunction with a right-side study; the problem with doing so is the minuscule additional reimbursement for 93622 (and 93621) vis--vis 93620.
Therefore, the real impact of the change will be known only when the relative values for 93621 and 93622 are known. The current figures are:
93620 (19.41 transitioned relative value units).
93621 (21.20 RVUs).
93622 (21.32 RVUs).
If the RVU for the add-on codes is equally small, not much will have changed, notes Nikki Vendegna, CPC, a cardiology coding and reimbursement specialist in Overland Park, Kan. "It all depends on how much they ratchet down reimbursement for 93621 and 93622," Vendegna says, noting that if CMS follows a similar model to that used for interventions on additional vessels, reimbursement may be cut severely.
If both left atrial and left ventricular studies are performed in conjunction with 93620, both 93621 and 93622 should be reported. This service is now correctly reported using 93621 (for the right-side and left atrial study) and 93607 (for the left ventricular study).
Modifier -60 Deleted; Modifier -22 Revised
Modifier -60 (altered surgical field) has been deleted only one year after its introduction. The deletion is tacit acknowledgment that CMS and other carriers did not accept the new modifier, despite general praise for it from physician groups. A few weeks after the modifier was introduced, CMS announced that Medicare carriers would not recognize the modifier and instructed providers to continue using modifier -22 (unusual procedural services) in such cases.
CPT 2001 had amended modifier -22, stating that "this modifier is not to be used to report procedure(s) complicated by adhesion formation, scarring, and/or alteration of normal landmarks due to late effects of prior surgery, irradiation, infection, very low weight ... or trauma (see modifier -60 as appropriate)."
With modifier -60 deleted, modifier -22 should be used to report complicated procedures, regardless of the reason for the difficulty.
