Cardiology Coding Alert

Question: When EP codes refer to recording and pacing, what does this mean?

New York Subscriber

Answer: Recording means the electrophysiologist (EP) places an electrode in a certain location in the heart and assesses the electrical activity in that area. For instance, you would report 93600 (Bundle of His recording) if the physician placed an electrode at the bundle of His and recorded electrical activity. You would report 93602 (Intra-atrial recording) for intra-atrial recording and 93603 (Right ventricular recording) when the physician recorded activity in the right ventricle.

Pacing means the EP administers electrical impulses to specific areas in the heart. Pacing allows the physician to assess how various portions of the heart react to electrical impulses. Specifically, the physician may perform pacing to evaluate whether certain pathways of the heart carry electrical impulses to appropriate locations and the speed of the conducted impulses. For instance, you would report 93610 (Intra-atrial pacing) when the physician paces from the atrium and 93612 (Intraventricular pacing) for intraventricular pacing. For both pacing and recording, you'll need to check the note carefully to assess what the physician did.

Remember: In many cases, the physician will perform a comprehensive EP study, such as 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) or 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).

These "package" codes include pacing from the atrium and ventricle as well as recording from the atrium, ventricle, and His bundle, so you should not report the component codes separately.

Bonus tip: You're likely to see the 93620 service performed more often than the 93619 service, but let the documentation guide your code choice.