Cardiology Coding Alert

Never report codes 93612 or 93618 in conjunction with comprehensive EP study codes 93619-+93622.

If you read the article “3 Tips Sharpen Your Comprehensive EP Study Reporting Skills,” found in Cardiology Coding Alert Vol. 22, No. 9, you learned all about the best practice for reporting comprehensive electrophysiologic (EP) study codes 93619 and 93620.

But, do you know which codes you should report if your cardiologist performs a limited EP study instead of a comprehensive EP study?

Read on to keep your limited EP claims in tip-top shape.

Report These Codes for Limited EP Studies

CPT^® offers the following codes for limited EP studies:

• 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).

“Codes 93600-93603, 93610, 93612, and 93618 are used to describe unusual situations where there may be recording, pacing, or an attempt at arrhythmia induction from only one site in the heart,” according to the CPT^® guidelines. 

In the case of single site studies, you must carefully read the procedure note and highlight which areas the physician placed the catheters, if the physician performed pacing and recording, and if the physician induced or attempted to induce an arrhythmia, says Carol Hodge, CPC, CDEO, CCC, CEMC, certified medical coder at St. Joseph’s Cardiology in Savannah, Georgia.

“If only one site is selected, then it is a single site study,” Hodge says. “If more than one site is selected, then look to 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) and 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) and determine if an arrhythmia was induced or if an attempt was made to induce an arrhythmia.”

You should not report any of the above codes when the cardiologist performs an ablation, Hodge adds. These codes only apply when the cardiologist performs an EP study without ablation.

Focus on 2 Examples to Understand Limited EP Study Coding

One coding tip to help you correctly report the limited EP study codes is to review the CPT^® introductory coding guidelines for Intracardiac Electrophysiological Procedures/Studies and carefully consider the CPT^® code definitions, says Cynthia A. Swanson, RN, CPC, CEMC, CHC, CPMA, of ClaimDOC in Des Moines, Iowa. In this code section, there are many “use with” and “do not report” with guidelines.

You should always review each procedure and operative report carefully to select the most appropriate code(s) for the services the cardiologist performed, Swanson adds.

To further help you understand how to appropriately report limited EP studies, take a look at the following two examples:

Example 1: The cardiologist documented that he performed an atrial EP study without ablation that included bundle of His recording, induction of arrhythmia, and right atrial pacing and recording in the hospital.

When the cardiologist does not perform the full-service EP package, you should report the individual components with their respective CPT^® codes. So, you would report 93618-26 for the induction of arrhythmia, 93610-26 for the right atrial pacing, 93602–26 for right atrial recording, and 93600-26 for the bundle of His recording. This includes when the cardiologist also paces and records the left atrial from the coronary sinus or left atrium.

Caution: When the cardiologist does not perform a complete 93619 or 93620, and he performs an atrial study only, you should not report add-on code +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)), explains Christina Neighbors, MA, CPC, CCC, Coding Quality Auditor for Conifer Health Solutions, Coding Quality & Education Department, and member of AAPC’s Certified Cardiology Coder steering committee.

Code +93621 is included in the atrial study codes 93600, 93602, 93610, and 93618, when performed, Neighbors explains. Code +93621 has a list of procedures it can be added onto, so always read the guidelines. Also, append modifier 26 (Professional component) accordingly.

Example 2: The cardiologist performs a ventricular diagnostic study only, with no ablation. He performs bundle of His recording, right ventricular recording, and intra-ventricular pacing. He also performs induction of arrhythmia by electrical pacing. You should report the following codes:

• 93600
• 93603
• 93612
• 93618.