Cardiology Coding Alert

Get the lowdown on coding left-side approaches and 3-D mapping

If you use comprehensive electrophysiologic study (EPS) codes 93619 and 93620, you should be reporting add-on codes for the physician's related procedures. Use our expert's advice to ensure you link the correct codes together. How to Code Left-Side Pacing and Recording Physicians pace and record the heart's left side using special approaches, which means you'll need more than comprehensive EPS codes (93619 and 93620) to accurately report the work.

The procedure: To reach the left side, the physician accesses the heart through the patient's coronary sinus, transseptal puncture, or a retrograde left-heart catheter.

Your coding options: You should use the following add-on codes:

+93621 - ... with left atrial pacing and recording from coronary sinus or left atrium (list separately in addition to code for primary procedure). This procedure involves the EP physician placing a catheter in the coronary sinus, which is the vein that terminates in the right atrium and wraps externally around the heart's left side, says Anne C. Karl, RHIA, CCS-P, CPC, coding and compliance specialist at St. Paul Heart Clinic in Mendota Heights, Minn.

+93622 - ... with left ventricular pacing and recording (list separately in addition to code for primary procedure). This code represents left ventricular recording and pacing, which requires either arterial access or transseptal puncture, says Laura Siniscalchi, RHIA, CCS, CCS-P, CPC, manager of Healthcare & Life Sciences Regulatory Practice at Deloitte & Touche LLP in Boston. Remember that CPT guidelines require you to attach these codes only to comprehensive EPS code 93620, Siniscalchi says.

Bill 2 Types of Mapping Procedures You should know how to code the two types of "mapping" the physician uses after inducing an arrhythmia. The "mapping" process allows the physician to pinpoint the source of the electrical abnormality, coding experts say.

What to do: If the cardiologist performs 2-D mapping, which involves mapping the tachycardia, you should list +93609 (Intraventricular and/or intra-atrial mapping of tachycardia site[s] with catheter manipulation to record from multiple sites to identify origin of tachycardia [list separately in addition to code for primary procedure]).

When the cardiologist performs 3-D EP mapping, submit +93613 (Intracardiac electrophysiologic 3-dimensional mapping [list separately in addition to code for primary procedure]).

Caution: Because 2-D and 3-D mapping have many similarities, you should rely on the physician's documentation to help you choose between the two codes. "Our policy is that if the EP physician does not specify either '3-D mapping' or the specific catheter he utilized, such as ESI EnSite NavX, then we bill for 2-D mapping," Karl says.

Whichever mapping code you select, you should attach these add-on codes to only three codes:

93620 - Comprehensive electrophysiologic evaluation ...

 93651 - Intracardiac catheter [...]