Cardiology Coding Alert

Question: Our electrophysiologist (EP) noted in an EP report that he performed a "comprehensive electrophysiology study with successful induction of arrhythmia." In the report, however, he mentioned that ventricular pacing "was contraindicated and therefore deferred." He thinks that he performed the bulk of the comprehensive study and would like to bill it with 93620. Is this appropriate?

Wisconsin Subscriber Answer: No, reporting 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) would not be appropriate.  

To report a comprehensive EP study (93619 or 93620), the physician must perform and document all of the comprehensive study subcomponents. These include pacing and recording from the right atrium, pacing and recording from the right ventricle, and recording from the bundle of His. To report 93620 correctly, the note must show that the physician attempted arrhythmia induction in addition to these five subcomponents. 

When the physician does not perform the full package of services, you should report the individual components with their respective CPT codes. In your case, the physician performed all of the subcomponents of 93620 with the exception of right ventricular pacing. So you would report 93602 (Intra-atrial recording), 93610 (Intra-atrial pacing), 93603 (Right ventricular recording), 93600 (Bundle of His recording) and 93618 (Induction of arrhythmia by electrical pacing). Had the physician also performed ventricular pacing, you would report +93621 (Comprehensive electrophysiologic evaluation ...; with left atrial pacing and recording).       

-- You Be the Coder and Reader Questions were prepared with the assistance of Jim Collins, ACS-CA, CHCC, CPC, president of Compliant MD Inc. and compliance manager for several cardiology groups around the country; and reviewed by Jerome Williams Jr., MD, FACC, a cardiologist with Mid Carolina Cardiology in Charlotte, N.C.