Cardiology Coding Alert

Question: I use 93641 for electrophysiologic (EP) testing of ICD leads/generator at the time that the cardiologist initially inserts the ICD. Is the testing that the cardiologist performs the day after included in the global period, or is this separately reportable? If so, which CPT code should I use?

Mississippi Subscriber

Answer: The pacemaker insertion's global period does not apply to ICD checks or reprogramming. Therefore, you may report testing that the cardiologist performs the day after with the appropriate code (93741, 93742, 93743 or 93744) when indicated. The medical necessity for a device interrogation on the day immediately following an implant will be there for many patients, but not on a large percentage of them.

If, however, the cardiologist actually performed a non-invasive programmed stimulation (NIPS) on the following day (as opposed to an EP test at the time of implant), make sure you report this service with 93642 (Electrophysiologic evaluation of single or dual chamber pacing cardioverter-defibrillator [includes defibrillation threshold evaluation, induction of arrhythmia, evaluation of sensing and pacing for arrhythmia termination, and programming or reprogramming of sensing or therapeutic parameters]).

Cardiologists sometimes postpone this EP test of the defibrillation system until after the patient has a chance to stabilize. Typically, the cardiologist will not perform the EP study at the time of the implant (93641, Electrophysiologic evaluation of single or dual chamber pacing cardioverter-defibrillator leads including defibrillation threshold evaluation ...) and a NIPS (93642) on the following day.

And many cardiologists will wait for a week or so after implantation to reprogram the device after the initial implantation. You should report interrogation and reprogramming separate from the above-mentioned EP system tests.