Cardiology Coding Alert

Question: For an EP test of an internal cardioverter-defibrillator (ICD) at implant, should we report 93619 or 93620?

Massachusetts Subscriber

Answer: Neither. When the cardiologist uses an electrophysiology (EP) test for an ICD device, he induces an arrhythmia and confirms that the device is functioning properly. To report an ICD evaluation at the time of initial implantation, you have two coding options:

1. When the physician tests the lead(s) only, report 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).

2. When the physician tests the lead(s) and generator, assign 93641 (... with testing of single or dual chamber pacing cardioverter-defibrillator pulse generator).

Caution: You mentioned 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 should report these codes only for comprehensive EP studies. 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.

Bonus tip: Physicians rarely complete a comprehensive EP study after implanting a device during the same session. However, comprehensive EP studies before implanting a device have proven medically necessary to assist in identifying the underlying diagnosis and plan of care.