Cardiology Coding Alert

Question: Can I report and receive reimbursement for an A-line during a four-wire electrophysiology (EP) study and ablation?

Utah Subscriber

Answer: Yes, if the only catheter the cardiologist places in the arterial access is the monitoring catheter, you can report 36620 (Arterial catheterization or cannulation for sampling, monitoring or transfusion [separate procedure]; percutaneous).

However, you'll have to prove that the cardiologist performed this service as a separately identifiable procedure and apply modifier -59 (Distinct procedural service) to 36620 to bypass a National Correct Coding Initiative (NCCI) edit.

NCCI bundles this code into EP study codes 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).

You can circumvent the bundle with modifier -59, as long as you show how the cardiologist performed 36620 as a separate service. Because NCCI reasoned this edit as "standards of medical/surgical practice," you will have to show how 36620 was unrelated to intraoperative monitoring.

Be prepared: Many insurers will view any code with a "separate procedure" descriptor included in the CPT definition to mean that you cannot report this code with any other procedure. That is not true.