Cardiology Coding Alert

You'll be well on the way to coding comprehensive intracardiac electrophysiologic studies (EPS) correctly if you know two crucial things: where the physician positioned the catheters and whether he or she attempted arrhythmia induction. Electrophysiologists perform comprehensive EPS with and without inducing arrhythmia to evaluate such problems as syncope of uncertain origin and suspected supraventricular tachycardias.

The procedure involves inserting multiple transvenous electrode catheters in the high right atrium, His bundle region and right ventricle. The physician then performs right atrial pacing and recording, His bundle recording, and right ventricular pacing and recording, according to the American College of Cardiology's (ACC) Guide to CPT 2003.

Next, the physician either assesses the conduction intervals and concludes the EPS or continues the study by inducing arrhythmias, diagnosing their mechanism, and terminating the arrhythmias by pacing methods or countershock, the ACC guide states. Report codes in the 93619-93622 range, depending on whether the physician attempted arrhythmia and whether the study included left atrial recording or left ventricular recording and pacing. Remember to append modifier -26 (Professional component) to comprehensive EPS and add-on codes if the physician is performing the procedure in a facility.

Be sure to check National Correct Coding Initiative (NCCI) edits because NCCI often bundles EPS codes, says Sandy Fuller, CPC, a cardiology coding and reimbursement specialist in Abilene, Texas.

Coding experts offer the following tips for reporting comprehensive EPS codes correctly: 93619: Look for the Catheter Trio When the physician indicates that he or she placed three catheters one in the right atrium, one in the right ventricle and one in the His bundle report 93619 (Comprehensive electrophysiologic evaluation with right atrial pacing and recording, right ventricular pacing and recording, His bundle recording, including insertion and repositioning of multiple electrode catheters, without induction or attempted induction of arrhythmia), says Anne C. Karl, RHIA, CCS-P, CPC, a coding and compliance specialist with the St. Paul Heart Clinic in Mendota Heights, Minn.

"In this study, the physician is recording the electrical signals in the three noted areas and performing pacing within the right atrium and right ventricle," Karl says. "There will not be an attempt to induce an arrhythmia."

Moreover, remember that 93619 includes the services represented by codes 93600 (Bundle of His recording), 93602 (Intra-atrial recording),93610 (Intra-atrial pacing) and 93612 (Intraventricular pacing),so you should not report these codes with 93619, the ACC coding guide states. In addition, you should not report 93618 (Induction of arrhythmia by electrical pacing) or 93620-93622 with 93619, CPT says, because 93619 is a comprehensive procedure that does not include arrhythmia induction. If you use the comprehensive EP codes (93619-93620), you cannot use the unbundled codes also, says Rebecca Sanzone, CPC, billing manager for Midatlantic Cardiovascular Associates of [...]