Cardiology Coding Alert

Read on to always report clean EP study claims in your practice.

Why Providers Perform EP Studies

To perform an EP study, your cardiologist will insert specialized catheters and wire electrodes to measure the electrical activity through the blood vessels that enter the patient’s heart. Your cardiologist may choose to perform an EP study when they need to assess the heart’s electrical system/activity. This study aids the cardiologist in diagnosing abnormal heartbeats or arrhythmias.

When your cardiologist records and maps the conduction system, they can identify any electrical impulse abnormalities causing the arrhythmia. Then they can determine and provide appropriate treatment options. This treatment is often an interruption of the abnormal pathway, by ablating the pathway with radiofrequency (heat) or cryo (cool) ablation catheters.

Electrical heart activity issues explained: When the conduction of the electrical activity of the heart is not synchronized due to the normal pathways being interrupted by infarct and scarring, patients can experience irregular and asynchronous electrical conduction. In turn new pathways may be created, causing abnormal heart rhythms such as atrial fibrillation, atrial flutter, supraventricular tachyarrhythmia (SVT), and ventricular tachycardia.

Rely on These CPT^® Codes for Comprehensive EP Study

When your cardiologist performs a comprehensive EP study, you can look to the following 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). Coding tip: If your cardiologist performs the comprehensive EP study without induction or attempted induction of an arrhythmia, report 93619.
• 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). Coding tip: If your cardiologist makes any attempt at induction (successful or not), report 93620.

Remember 5 Components for Comprehensive EP Study

When a provider performs a comprehensive EP study, they will insert multiple electrode catheters in the patient’s high right atrium, His bundle region, and right ventricle. To qualify as a comprehensive study, the provider must perform all of the following components:

1. Right atrial recording
2. Right atrial pacing
3. Right ventricular pacing
4. Right ventricular recording
5. Bundle of His recording

Coding tip: If the documentation does not reflect all of the above components in the operative report, the study is not considered comprehensive. Therefore, report each component individually based on the specific procedure(s) your cardiologist performed and documented.

Know When to Report Limited EP Codes

In some instances, your cardiologist may perform a limited EP study instead of a comprehensive one. If that is the case, you can look at the following codes:

• 93600 (Bundle of His recording)
• 93602 (Intra-atrial recording)
• 93603 (Right ventricular recording)
• 93610 (Intra-atrial pacing)
• 93612 (Intraventricular pacing)
• 93618 (Induction of arrhythmia by electrical pacing).

To correctly report a limited EP study, you must ensure that your cardiologist performed recording, pacing, or an attempt at arrhythmia induction from only one site in the heart. If only one site is selected, then it is a single-site study. If more than one site is selected, instead look to comprehensive EP study codes 93619 and 93620.

Coding tip: Never report 93600-93603, 93610, 93612, or 93618. You should not report any of the above codes when your cardiologist performs an ablation. These codes only apply when the cardiologist performs an EP study without ablation.

“If your physician performed an ablation during the same setting as the EP study, look to EP codes 93653-93657 depending on the type of arrhythmia ablated,” says Robin Peterson, CPC, CPMA, manager of professional coding and compliance services, Pinnacle Enterprise Risk Consulting Services, LLC in Centennial, Colorado.