Cardiology Coding Alert

Question: What's the difference between recording and pacing during an electrophysiologic (EP) study, and how should I bill for each service?

California Subscriber

Answer: Recording is what the electrophysiologist is doing when he or she 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 places an electrode at the bundle of His and records electrical activity. You would report 93602 (Intra-atrial recording) for intra-atrial recording and 93603 (Right ventricular recording) when the physician records activity in the right ventricle.
 
When the electrophysiologist administers electrical impulses to specific areas in the heart, he or she is "pacing" that location. 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.
 
In many cases, you would report a comprehensive EP study with 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). This "package" code includes pacing from the atrium and ventricle as well as recording from the atrium, ventricle and His bundle.