Cardiology Coding Alert

Check whether your cardiologist performed induction or attempted induction of arrythmia.

If you’ve ever wondered how to wade through the numerous procedure codes for an electrophysiological (EP) study, the recent Virtual HEALTHCON talk “Coding Electrophysiological Study (EP)” was the perfect session for you.

Take a look at what speaker Srivalli Harihara, CPC, PGPAIML had to say about coding for comprehensive EP studies.

Editor’s note: Stay tuned next month to hear from speaker Leigh Poland, RHIA, CCS, and learn about which codes you should report when your cardiologist performs an ablation procedure during the same session as an EP study.

Understand Why Cardiologists Perform EP Studies

An EP study is a test performed to assess the heart’s electrical system/activity and is used to diagnose abnormal heartbeats or arrhythmias, according to Harihara. This test is usually performed by inserting specialized catheters and then wire electrodes, which measure the electrical activity through the blood vessels that enter the heart.

When the conduction of the electrical activity of the heart is not synchronized due to the normal pathways being interrupted by infarct and scarring, irregular and asynchronous electrical conduction can occur, she said. Over time, new pathways may be created, which causes abnormal heart rhythms like atrial fibrillation, atrial flutter, supraventricular tachyarrhythmia (SVT), and ventricular tachycardia.

Recording and mapping of the conduction system allows the physician to identify any electrical impulse abnormalities causing this arrhythmia. From that, they will be able to determine and provide appropriate treatment options, Harihara added. This treatment is often an interruption of the abnormal pathway, by ablating the pathway with radiofrequency (heat) or cryo (cool) ablation catheters.

Look at These Comprehensive EP Codes

Most EP studies involve pacing and recording of the electrical pathways in the right ventricle and the right atrium and recording of the electrical pathway in the bundle of His, Harihara said. All of these activities are described by the following two comprehensive 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)
• 93620 (Comprehensive electrophysiologic evaluation including insertion and repositioning of multiple electrode catheters with induction or attempted induction of arrhythmia; with right atrial pacing and recording, right ventricular pacing and recording, His bundle recording)

Don’t miss: As you can see, the only difference between codes 93619 and 93620 is whether the induction for arrhythmia is performed during the study, according to Harihara. Code 93619 is without induction or attempted induction, and code 93620 is with induction or attempted induction.

Apply What You’ve Learned With This Case Study

Harihara gave this example to explain how to properly code a comprehensive EP study: A patient with atrial flutter was brought to the EP lab in the post absorptive state. Informed consent was obtained for the procedure and conscious sedation was performed. The physician and nurse confirmed the presence of the correct patient and procedure. The patient was monitored with ECG, external pacemaker-defibrillator, pulse oximetry, and non-invasive blood pressure monitoring. The right groin was prepped and draped in the usual sterile fashion. Local anesthesia was obtained with 1 percent lidocaine/0.5 percent bupivacaine. The right femoral vein was cannulated using the modified Sedinger technique using one 0.035 guidewire. One 5-French and two 6-French sheaths were inserted into the femoral vein. Three 5-French Quadrapolar catheters were advanced into the heart with fluoroscopic guidance. Initially the catheters were placed in the high right atrium at the His bundle and in the right ventricular apex. Measurements of refractory periods and conduction intervals were performed. Programmed stimulation was performed. The patient presented in atrial flutter, so induction was not performed. Following the procedure, the catheters and sheaths were removed. Hemostasis was obtained using manual compression. The patient continued to have atrial flutter.

Solution: Report 93619 on your claim because induction was not performed.

Don’t Miss Add-on Codes for Comprehensive EP Study

There are two different CPT^® codes that describe the performance of pacing and recording in the left atrium and the left ventricle when performed at the same time as the comprehensive EP study, Harihara says. These codes are:

• +93621 (Comprehensive electrophysiologic evaluation including insertion and repositioning of multiple electrode catheters with induction or attempted induction of arrhythmia; with left atrial pacing and recording from coronary sinus or left atrium (List separately in addition to code for primary procedure))
• +93622 (… with left ventricular pacing and recording (List separately in addition to code for primary procedure))

Use these add-on codes when the pacing or recording is performed on the left atrium or left ventricle, according to Harihara. Code +93621 may be reported in addition to 93620. Code +93622 may be reported in addition to codes comprehensive EP study codes 93620 and 93656 (Comprehensive electrophysiologic evaluation including transseptal catheterizations, insertion and repositioning of multiple electrode catheters with intracardiac catheter ablation of atrial fibrillation by pulmonary vein isolation, including intracardiac electrophysiologic 3-dimensional mapping, intracardiac echocardiography including imaging supervision and interpretation, induction or attempted induction of an arrhythmia including left or right atrial pacing/recording, right ventricular pacing/recording, and His bundle recording, when performed).