EP Op Report:
Eliminate Coding Confusion When You're Faced With Unusual EP Studies
Published on Tue Aug 22, 2006
Tip: If you're thinking of using an add-on code, you cannot report that code alone
When your electrophysiologist (EP) performs a procedure that doesn't have a perfect code to represent it, you may find yourself caught in a quagmire of possible coding options that you know aren't right. Follow this example and see how to tackle even the most unusual operative reports with ease. Review This EP Note Example Procedures
Administration of intravenous stimulants for detection of ventricular ectopy. History
This 41-year-old patient has a history of symptomatic, late diastolic PVCs. They were thought to have an outflow tract origin. She underwent admission for potential electrophysiologic evaluation and possible mapping and ablation. 12-Lead Electrocardiogram
The 12-lead electrocardiogram at rest indicated sinus rhythm. Minor J point elevation was present in lead V1. Noted accentuation of T wave voltage in lead V2. Description of Procedure
After providing written and informed consent, the patient was taken to the electrophysiologic laboratory in a postabsorptive nonsedated state. After the initial nursing assessment, the patient was placed in the supine position on a padded procedure table. I established noninvasive blood pressure and arterial oxygen saturation monitoring. I established continuous electrocardiographic monitoring. I started supplemental nasal oxygen. Then I applied anterior and posterior defibrillation pads to the chest. I obtained baseline electrocardiographic recordings. The patient had no ectopy at rest. Then I started her on intravenous isoproterenol. The initial dose was 1 mcg per minute. I subsequently increased in incremental doses to a total of 4 mcg per minute. I performed serial electrocardiograms following the administration of intravenous isoproterenol.
There was accentuation of T-wave voltage in V2 and minor ST segment elevation in V2. There was accentua-tion of J point elevation in V1. I observed neither arrhythmias nor ectopy. I thus discontinued the isoproterenol. After 20 minutes, the patient received 250 mg of intravenous aminophylline. Once again, I obtained serial electrocardiograms. There was no major change in electrocardiogram. The patient remained asymptomatic. I induced no ventricular ectopy. Discussion
Despite the fact that the patient demonstrated spontaneous ventricular ectopy on an outpatient basis and has been off of her beta blocker medications, the patient has no evidence of spontaneous or inducible ventricular ectopy today. Her mapping and ablation procedure was canceled. She will continue on medical therapy. Now Simplify What You Read If you found this example to be challenging, you're probably on the right track. "This is an unusual case," says Anne Karl, RHIA, CCS-P, CPC, coding and compliance specialist at St. Paul Heart Clinic in Mendota Heights, Minn.
First, you should break down what happened. The EP tried to induce ventricular ectopy using infusions of isoproterenol and aminophylline. He monitored her on EKGs throughout the procedure, but the patient proved asymptomatic.
Note: "Ectopy is abnormal [...]
