Cardiology Coding Alert

Don't let coding comprehensive intracardiac electrophysiologic studies (EPS) cause you headaches and your practice costly denials. To get the pay you deserve, use these expert tips to accurately report pacing and recording, as well as catheter placement and arrhythmia induction.

What "comprehensive" means: A comprehensive EPS means the physician inserted multiple electrode catheters in the high right atrium, His bundle region and right ventricle. The physician also performed right atrial pacing and recording, His bundle recording, and right ventricular pacing and recording.

"Our EP physician performs comprehensive studies when the patient has cardiac arrhythmias to determine if the arrhythmia has caused the patient's condition and to determine the best course of treatment," says Sarah Tupper, CMC, coder for Central New York Cardiology in Utica.

The procedure allows electrophysiologists to evaluate conditions like syncope (780.2, Syncope and collapse) and tachycardia (785.0, Symptoms involving cardiovascular system; tachycardia, unspecified), with or without inducing arrhythmia.

If the EP physician performs a comprehensive EPS, without inducing arrhythmia, you should report the "package" code 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), says Jim Collins, CPC-CARDIO, ACS-CA, CHCC, president of The Cardiology Coalition in Saratoga Springs, N.Y.

Remember that 93619 includes the codes for several of the EP physician's pacing and recording services. This means that if you report a comprehensive code, you should not separately report the following codes for the same visit:

• RA pacing and recording (93610, Intra-atrial pacing; and 93602, Intra-atrial recording)-

• RV pacing and recording (93612, Intraventricular pacing; and 93603, Right ventricular recording)

• Bundle of His recording (93600, Bundle of His recording).

On the other hand, be sure you assign 93619 only for comprehensive studies. "If the documentation in an EP study report does not mention the physician positioned the catheters in the right atrium, His bundle and right ventricle, you do not have a comprehensive study," Tupper says. "You then have to pick out what you do have and bill each one separately."
Scenario: The physician provides right atrial pacing and recording in addition to His bundle recording. In this case, report 93600, 93602 and 93610.

You cannot attach modifier 51 (Multiple procedures) to these codes, according to the CPT manual. And when the physician performs a comprehensive EPS in a facility, you should append modifier 26 (Professional component) to 93619, Tupper says.

You also have a second "package" code to consider when reporting comprehensive EPS.

Best way: When the physician induces or attempts to induce arrhythmia in addition to the full EP study defined above, you can submit 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), instead of 93619, Collins says.

Note: Even when the physician fails to induce arrhythmia, you can still use 93620. That's because the code specifies "induction or attempted induction of arrhythmia," coding experts say.

Include These Services With Second Package Code

This second package also includes a number of other services that you can't report in addition to 93620, according to CPT guidelines:

Another thing to remember is that the same modifier guidelines that apply to 93619 apply to 93620 as well.

Moral of the story: "You should have good communication with your electrophysiologists," Tupper says, "and educate them as to proper documentation. You need to state where they placed the catheters -- and why."