Wiki New 2013 EP study/ablation codes

[CPCCODERII]

Hi,
I listened to a Zhealth publishing 2013 Updates for Interventional Radiology, Cardiology and Endovascular Surgery webinar today and it briefly discussed the new 2013 EP codes. Could someone please clarify for me on how to bill when our provider performs an EP study, as well as an ablation, but does not perform a complete EP study and so therefore doesnt meet the requirements of billing 93653 or 93654. Do we need to append a 52 modifier to the CPT codes?

I dont have a specific operative report I am referring to, but in the past this provider has documented only partial EP studies (not going into the bundle of HIS, or not mentioning right atrial pacing), which we then billed out each component that he did mention, separately. Performing these limited EP studies is now causing us some some billing confusion, and I would like to make sure we bill these appropriately from the start.

Any help you can provide would be greatly appreciated!!

Thank you!!

 

[dpeoples]

Hi,
I listened to a Zhealth publishing 2013 Updates for Interventional Radiology, Cardiology and Endovascular Surgery webinar today and it briefly discussed the new 2013 EP codes. Could someone please clarify for me on how to bill when our provider performs an EP study, as well as an ablation, but does not perform a complete EP study and so therefore doesnt meet the requirements of billing 93653 or 93654. Do we need to append a 52 modifier to the CPT codes?

I dont have a specific operative report I am referring to, but in the past this provider has documented only partial EP studies (not going into the bundle of HIS, or not mentioning right atrial pacing), which we then billed out each component that he did mention, separately. Performing these limited EP studies is now causing us some some billing confusion, and I would like to make sure we bill these appropriately from the start.

Any help you can provide would be greatly appreciated!!

Thank you!!

IMO, if the procedure performed does not include each of the components in the description, then a 52 modifier is warranted.

HTH

 

[CPCCODERII]

Can I ask for your expertise once again??

Thank you for your help Danny, that did help. I also found an aritcle on the EP digest page which was very helpful too. I'm so glad we have the AAPC to reach out to, especially with these new codes.

I have an additional question...we had a patient present with an acute MI, 99.5% occlusion of LD artery. The physician performed a heart catheterization and suggested PCI w/ stenting to the patient. The patient wanted to wait a few days, so 3 days later the provider performed the PCI w/ stenting. We are questioning if we are able to use the 92941-LD since it was done on a later day? I am leaning towards yes, because per CPT it needs to be performed during a current presentation, and the patient did remain in the hospital, so I am viewing that as a "current session". Thoughts?

I apologize for not posting an operative report, but my system isnt allowing me to cut and paste and edit, so I would have to retype the entire report.

 

[j.monday7814]

personally, I disagree with adding the -52 modifier to the ablation codes when a partial EP study is performed during an ablation. In December, I listened to a webinar by Jim Collins of Cardiology Coder (EP Lab Digest and other cardiac societies respect him) and he knew this would be an issue with the new codes for partial EP studies. The end result was, after he submitted a letter to the AMA urging them to change the language in CPT, that the AMA listened and stated that not all of the components in a full EP study need to be performed during an ablation. Do not append a -52 modifier for that reason.

As for your second question, I agree that 92941 would be appropriate because its still during the initial hospital admission.

 

[debcpc]

92941

The CPT code 92941 was created to stress "Acute Myocardial Infarction". This code is for the patient coming into the hospital needing care right away. This would include situations whether STEMI or NON STEMI. The stress here is on the importance of the word "Acute". If you have access to the RUC database or the AMA's Coding Manager you would see a description of service that states " Percutaneous coronary intervention is planned immediately with the goal of achieving first medical contact-to-balloon time of under 90 minutes" The RUC values these codes according to the description of service (as well as other things).

Debra

 

[dpeoples]

Thank you for your help Danny, that did help. I also found an aritcle on the EP digest page which was very helpful too. I'm so glad we have the AAPC to reach out to, especially with these new codes.

I have an additional question...we had a patient present with an acute MI, 99.5% occlusion of LD artery. The physician performed a heart catheterization and suggested PCI w/ stenting to the patient. The patient wanted to wait a few days, so 3 days later the provider performed the PCI w/ stenting. We are questioning if we are able to use the 92941-LD since it was done on a later day? I am leaning towards yes, because per CPT it needs to be performed during a current presentation, and the patient did remain in the hospital, so I am viewing that as a "current session". Thoughts?

I apologize for not posting an operative report, but my system isnt allowing me to cut and paste and edit, so I would have to retype the entire report.

I don't think 92941 is appropriate since the MI is no longer "acute". I suggest 92928, depending on documentation.

HTH