Identify and Document Diagnosis and Medical Necessity for EPS, MRI and Endoscopy
Published on Thu Nov 01, 2001
Patients may receive anesthesia when undergoing certain diagnostic tests such as electrophysiological studies (EPS), magnetic resonance imaging (MRI) or endoscopies. However, Medicare and other carriers may deem the tests medically unnecessary or deny the anesthesia as elective. Many local medical review policies (LMRPs) state that diagnostic tests performed for screening purposes and the accompanying anesthesia are excluded from Medicare coverage. Therefore, the key to anesthesia reimbursement is knowing which procedures are covered, how to apply anesthesia codes, and which diagnosis codes and documentation support the medical necessity of the diagnostic tests and the anesthesia.
Electrophysiological Studies
According to LMRP for Cigna Healthcare, North Carolina's Medicare Part B carrier, EPS provides information about rhythm disturbances in the heart. The studies place catheter electrodes percutaneously and transluminally into the heart. The electrodes detect electrical activity within the heart and stimulate the atria or ventricles. These studies determine if a given therapy is controlling a patient's rhythm disturbances or identify if a patient is at risk for sudden cardiac death.
CPT Codes 2001 lists a number of codes associated with these studies. Emma LeGrand, CCS, coding supervisor with North Jersey Anesthesia Associates, P.C., a 53-physician practice in Florham Park, N.J., notes three common procedures:
CPT 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)
CPT 93651 intracardiac catheter ablation of arrhythmogenic focus; for treatment of supraventricular tachycardia by ablation of fast or slow atrioventricular pathways, accessory atrioventricular connections or other atrial foci, singly or in combination
CPT 93652 ... for treatment of ventricular tachycardia.
The corresponding anesthesia code for these procedures is 00537 (anesthesia for cardiac electrophysiologic procedures including radiofrequency ablation), which carries a base value of 10 units plus time units," LeGrand says. Laureen Jandroep, OTR, CPC, CCS-P, CPC-H, lead CPC trainer and consultant for A+ Medical Management & Education of Absecon, N.J., adds that the Coder's Desk Reference suggests using 00520 (anesthesia for closed chest procedures; [including bronchoscopy] not otherwise specified), which has a base value of six units plus time units. Jandroep and LeGrand advise coders to ask their carriers which anesthesia code is appropriate.
Barbara Johnson, CPC, MPC, professional coder, Loma Linda University Anesthesiology Medical Group Inc. of Loma Linda, Calif., reminds coders some carriers require the surgical code and the anesthesia code, while others may want just the anesthesia code. "In addition, the anesthesiologist can only bill one anesthesia code," Johnson says. "Pick the one with the highest number of base units, [...]
