Cardiology Coding Alert

Question: Before doing a complete EP study and A-fib ablation, the doctor turned off the ICD. Patient was placed on VVI, 40 beats per minute mode. After the main procedure was done, the ICD was reprogrammed to monitor plus therapy mode. Which code should I use for the ICD work?

Codify Member

Answer: Review code 93287 (Peri-procedural device evaluation [in person] and programming of device system parameters before or after a surgery, procedure, or test with physician analysis, review and report; single, dual, or multiple lead implantable cardioverter-defibrillator system). In the case you describe, the code applies to the evaluation and programming of the implantable cardioverter defibrillator (ICD) directly after the electrophysiology (EP) study and atrial fibrillation (A-fib) ablation. When reporting only the professional component, append modifier 26 (Professional component).

Device rep caution: You should report this code only if the physician performs and documents performing the ICD service. If a device representative performs the service, the physician should not code it.

Many payers may deny the code, so ensure your documentation will support an appeal. The doctor should specifically document that he's the one who performed the evaluation and programming. In addition, the documentation should describe medical necessity for the service and record the relevant data from the evaluation and programming. CPT® Assistant (February 2009) states, "This service entails the identification of the precise device manufacturer and model, retrieving and reviewing historical records, and collecting the appropriate equipment necessary to perform the evaluation. Similarly, the rate adaptive functions, paced rate, or sensing functions of a pacemaker or ICD may need to be adjusted prior to a procedure or operation and potentially restored after it."

In those cases where a physician does perform a full evaluation and programming before the main procedure, as well as after, then you may report 93287 twice (although your cardiology practice may not do this often on the same date).