Cardiology Coding Alert

Question: When the cardiologist performs an EP test of an internal cardioverter-defibrillator (ICD) implant, which code should we report, 93619 or 93620?

Michigan Subscriber Answer:  Neither. You should report 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) and 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) only for comprehensive electrophysiologic studies (EPS). In these comprehensive studies, the physician places multiple electrodes in the heart chambers to pace the right atrium and ventricle and to record data from the right atrium, bundle of His, and right ventricle.

On the other hand, when the cardiologist uses an EP test for an ICD device, he induces an arrhythmia and confirms that the device is properly functioning. To report an ICD evaluation, you have two coding options:

93640 - Electrophysiologic evaluation of single or dual chamber pacing cardioverter-defibrillator leads including defibrillation threshold evaluation [induction of arrhythmia, evaluation of sensing and pacing for arrhythmia termination] at time of initial implantation or replacement. Report this code when the physician tests both the leads and generator.

93641 - ... with testing of single or dual chamber pacing cardioverter-defibrillator pulse generator. Assign this code when the cardiologist tests only the leads.