smiller
Networker
Hello everyone - I need some help with this report (patient has RightVentricularOutflowTract PVCs- I billed with 93654 and 93623-26, but Humana has denied saying it was not supported by the dx). It's also been refiled with "AMA errata and corrections" attached which says that cpt 93623-26 is allowed with cpt 93654, so possibly cpts 93653, 93613, and 93623-26 might be the case...
Any help is welcome -
Here' s a copy of the report:
After prepping and draping in sterile fashion, the right groin area infiltrated with 1% lidocaine and the right femoral vein was cannulated with micropuncture times three and an 8-French and two 6-French venous sheaths were inserted. Two quadripolar catheters were inserted and placed into His bundle area as well as right ventricular apex. A 4 mm standard curved mapping and ablation catheter was inserted through the 8-French sheath and advanced to right atrium.
The patient's baseline intervals are within normal limits. AH interval is 128, HV 40, QRS interval 85, QT interval 330 and RR interval of 780 msec. We first performed geometry mapping using 3D mapping system (Carto). Right ventricular outflow tract, right ventricle, as well as proximal pulmonary artery were all mapped. After geometry was obtained, activation mapping of the PVCs was performed. The earliest activation site was found to be at the free wall region about 1.5 cm below pulmonic valve. The earliest activation site is 39 msec earlier than onset of PVC. Pace mapping was performed in this area, which showed a 99% match. We also mapped the surrounding area and didn't find any other earlier focus.
Radiofrequency ablation of the premature ventricular contractions was performed using 40 watts and 65 degrees and 60 seconds. Initial ablation was compromised because of catheter movement. Therefore, the 8-French sheath was exchanged to an SRO long sheath, which provided stability of the catheter. Further ablation was performed, which was able to eliminate the PVC. After about 10 lesions, we started the patient on Isuprel and titrated it up to 6 mcg. There was occasional nonclinical PVC noted, which has a morphology consistent with inferior RV in origin, negative QRS in two three aVF. No right ventricular outflow tract premature ventricular contractions post ablation, both in Isuprel infusion and during the wash out. We monitored the patient for 50 minutes, then declared the ablation successful.
All catheters were moved. Manual compression was applied to achieve hemostasis. The patient tolerated the procedure well and returned to the observation area in stable condition.
Thank you
Any help is welcome -
Here' s a copy of the report:
After prepping and draping in sterile fashion, the right groin area infiltrated with 1% lidocaine and the right femoral vein was cannulated with micropuncture times three and an 8-French and two 6-French venous sheaths were inserted. Two quadripolar catheters were inserted and placed into His bundle area as well as right ventricular apex. A 4 mm standard curved mapping and ablation catheter was inserted through the 8-French sheath and advanced to right atrium.
The patient's baseline intervals are within normal limits. AH interval is 128, HV 40, QRS interval 85, QT interval 330 and RR interval of 780 msec. We first performed geometry mapping using 3D mapping system (Carto). Right ventricular outflow tract, right ventricle, as well as proximal pulmonary artery were all mapped. After geometry was obtained, activation mapping of the PVCs was performed. The earliest activation site was found to be at the free wall region about 1.5 cm below pulmonic valve. The earliest activation site is 39 msec earlier than onset of PVC. Pace mapping was performed in this area, which showed a 99% match. We also mapped the surrounding area and didn't find any other earlier focus.
Radiofrequency ablation of the premature ventricular contractions was performed using 40 watts and 65 degrees and 60 seconds. Initial ablation was compromised because of catheter movement. Therefore, the 8-French sheath was exchanged to an SRO long sheath, which provided stability of the catheter. Further ablation was performed, which was able to eliminate the PVC. After about 10 lesions, we started the patient on Isuprel and titrated it up to 6 mcg. There was occasional nonclinical PVC noted, which has a morphology consistent with inferior RV in origin, negative QRS in two three aVF. No right ventricular outflow tract premature ventricular contractions post ablation, both in Isuprel infusion and during the wash out. We monitored the patient for 50 minutes, then declared the ablation successful.
All catheters were moved. Manual compression was applied to achieve hemostasis. The patient tolerated the procedure well and returned to the observation area in stable condition.
Thank you