Find Clarity When Coding IV Drug Infusion During This EP Procedure
No surprise: Supporting documentation is crucial to accurately billing +93623. Electrophysiology (EP) ablation studies may be performed to attempt to induce heart arrhythmias by altering the heart rhythm in hopes of diagnosing abnormal beat patterns. When these procedures are performed, an intravenous (IV) drug infusion may be performed as well. Cardiology coders need to know when to bill this service separately as an add-on code. Keep reading to find out more about coding IV drug infusions used for EP studies. See What Makes +93623 Unique CPT® code +93623 (Programmed stimulation and pacing after intravenous drug infusion (List separately in addition to code for primary procedure) is used during EP ablation studies to attempt to induce an arrythmia. This service should be used to alter the heart rhythm for diagnosing abnormal patterns. This should be done prior to a successful ablation of an arrythmia. When this service is performed to only check the efficacy of the ablation procedure, it is considered a nonbillable service. Code +93623 can only be billed once per encounter. When performing intravenous drug infusion to check pulmonary vein (PV) connections during a pulmonary vein isolation procedure, code 93656 (Comprehensive electrophysiologic evaluation with transseptal catheterizations, insertion and repositioning of multiple electrode catheters, induction or attempted induction of an arrhythmia including left or right atrial pacing/recording, and intracardiac catheter ablation of atrial fibrillation by pulmonary vein isolation, including intracardiac electrophysiologic 3-dimensional mapping, intracardiac echocardiography with imaging supervision and interpretation, right ventricular pacing/recording, and His bundle recording, when performed); do not bill +93623 separately. When attempting to induce an arrythmia, drugs like isoproterenol (Isuprel), atropine, dobutamine, and epinephrine may be used. When attempting to suppress arrhythmia, adenosine may be used. Remember to Associate +93623 With EP Ablation Procedures Keep in mind that this service is an add-on code that is almost always exclusively billed with EP ablation procedures. Sometimes, with the appropriate supporting documentation, +93623 is separately billable with some EP ablation procedure codes. You may be able to code +93623 with the following EP ablation codes: Check Out This Documentation Example If you’re wondering what constitutes appropriate documentation in this situation, consider the following: “The patient was appropriately prepped and draped. The patient was then administered with sedation by anesthesia. At baseline, the patient presented with mild premature ventricular contractions (PVC). Isuprel was administered with significant increase in PVC burden. It was then decided to move forward with the ablation.” In this example, we see that the documentation supports the appropriate use of the code +93623, including where the patient’s arrythmia was at the beginning of the procedure, the positive or negative response from the drug, and whether the decision is to move forward with the ablation or to discontinue if the provider felt that the ablation was in fact not supported. In this case, the PVC burden was increased due to the administration of the drug. Whenever you’re billing EP ablation studies that use IV drugs, be sure to review the documentation thoroughly to ensure that add-on code +93623 is supported. Make sure you’re justified in billing the service instead of billing it simply because the provider performed the service. Cristin Robinson, CPC, CPMA, CCC, CRC, CEMC, Education Coding Consultant, Bristol, Tennessee
