jtuominen
Guru
I was in a webinar today and the host discussed the appropriate indicators necessary to code 93620 vs. the component codes for an EP study. I left feeling a bit confused because I wrote down that I had thought they had stated the documentation of A-H and H-V interval values is sufficient all on its own in order to bill the comprehensive EP study code 93620, even if the doctor states catheter placement only in the atrium and CS, and even if the doctor only discusses burst atrial pacing and recording. So, based on that piece of information, I posed the following dictation for discussion to them, I am wondering also how others may interpret the correct coding of this case as well. Give it and read and let me know what you think. Thanks!
PROCEDURES PERFORMED: EP study and ablation.
INDICATION: Atrial flutter.
HISTORY OF PRESENT ILLNESS: This is a delightful 65-year-old
gentleman with a history of coronary artery disease and mitral valve
repair and had a history of postoperative atrial fibrillation.
Recently he was noted to be in a wide complex tachycardia with a
right bundle-branch block identical to his baseline morphology. It
appears to be typical atrial flutter based on the morphology of the
flutter waves. Due to the severity of symptoms he underwent a
cardioversion one week ago. Given the likelihood that it will recur
again, the patient was referred for EP study and ablation.
METHOD: After obtaining informed consent, the patient was prepped
and draped in the usual fashion. Conscious sedation was
administered. One-percent lidocaine was infiltrated into the right
femoral area. 6, 7, and 8 French sheaths were then placed in the
right femoral vein via the Seldinger technique. A deflectable
decapolar catheter was placed in the CS and a duodecapolar catheter
was placed around the TV annulus. Burst atrial pacing was then
performed. Additionally, atrial extrastimuli up to triples were then
performed.
Although no SVT was inducible, based upon the morphology of the
patient's clinical tachycardia it was decided to ablate the
cavotricuspid isthmus. Therefore an 8 mm ablation catheter was then
advanced into the RA. Ablation was then performed using EPT
generator.
Post ablation, burst atrial pacing was then performed. Additionally,
atrial extrastimuli up to triples were then repeated at baseline and
with 2 mcg of Isuprel. At the conclusion of the study catheters and
sheaths were then removed. Hemostasis was achieved by direct manual
pressure. The patient was then transferred back to the Care Suites
in stable condition.
CONDUCTION INTERVALS:
1. P-R 187, AH 91, H-V 46.
2. A-V nodal Wenckebach was 370, A-V nodal ERP was 600/260.
ABLATION SUMMARY: Four applications of radiofrequency ablation were
targeted at the cavotricuspid isthmus at 70 watts and 60 degrees
Celsius for 120 seconds. Bidirectional block was demonstrated and
was still present at 30 minutes post ablation.
COMPLICATIONS: None.
PROCEDURES PERFORMED: EP study and ablation.
INDICATION: Atrial flutter.
HISTORY OF PRESENT ILLNESS: This is a delightful 65-year-old
gentleman with a history of coronary artery disease and mitral valve
repair and had a history of postoperative atrial fibrillation.
Recently he was noted to be in a wide complex tachycardia with a
right bundle-branch block identical to his baseline morphology. It
appears to be typical atrial flutter based on the morphology of the
flutter waves. Due to the severity of symptoms he underwent a
cardioversion one week ago. Given the likelihood that it will recur
again, the patient was referred for EP study and ablation.
METHOD: After obtaining informed consent, the patient was prepped
and draped in the usual fashion. Conscious sedation was
administered. One-percent lidocaine was infiltrated into the right
femoral area. 6, 7, and 8 French sheaths were then placed in the
right femoral vein via the Seldinger technique. A deflectable
decapolar catheter was placed in the CS and a duodecapolar catheter
was placed around the TV annulus. Burst atrial pacing was then
performed. Additionally, atrial extrastimuli up to triples were then
performed.
Although no SVT was inducible, based upon the morphology of the
patient's clinical tachycardia it was decided to ablate the
cavotricuspid isthmus. Therefore an 8 mm ablation catheter was then
advanced into the RA. Ablation was then performed using EPT
generator.
Post ablation, burst atrial pacing was then performed. Additionally,
atrial extrastimuli up to triples were then repeated at baseline and
with 2 mcg of Isuprel. At the conclusion of the study catheters and
sheaths were then removed. Hemostasis was achieved by direct manual
pressure. The patient was then transferred back to the Care Suites
in stable condition.
CONDUCTION INTERVALS:
1. P-R 187, AH 91, H-V 46.
2. A-V nodal Wenckebach was 370, A-V nodal ERP was 600/260.
ABLATION SUMMARY: Four applications of radiofrequency ablation were
targeted at the cavotricuspid isthmus at 70 watts and 60 degrees
Celsius for 120 seconds. Bidirectional block was demonstrated and
was still present at 30 minutes post ablation.
COMPLICATIONS: None.
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