Cardiology Coding Alert

Question: What is the difference between 93640 and 93641? Can I report both codes at the same time?

Ohio Subscriber

Answer: Code 93640 (Electrophysiologic evaluation of single or dual chamber pacing cardioverter-defibrillator leads including defibrillation threshold evaluation [induction of arrhythmia, evaluation of sensing and pacing for arrhythmia termination] at time of initial implantation or replacement) includes defibrillator lead testing, and 93641 (... with testing of single or dual chamber pacing cardioverter-defibrillator pulse generator) includes testing the leads and the generator.
 
You cannot submit these codes on the same day for the same patient because 93641 indicates that you are performing a service that includes device testing, and 93640 indicates that you are doing the same service but without device testing. And, a National Correct Coding Initiative edit establishes these services as mutually exclusive of each other. 
 
Typically, when the physician tests the entire device, report 93641 and append modifier-26 for the professional component. To confirm that your physician provided this service, the documentation should reflect the induction of an arrhythmia to test the device's response and the corresponding defibrillation response from the device (usually measured in "joules") to abort the arrhythmia. For example, when the physician induces arrhythmia, he or she may document the procedure with the following information: "While pacing at the right ventricular apex at paced cycle length of 400 msec with coupling intervals of 224 and 192 msec, sustained ventricular fibrillation was induced." 
 
The documentation supporting 93641 would look something like, "The arrhythmia was immediately sensed by the device and terminated with one 360-joule shock back to sinus rhythm." Code 93640-26 describes testing the leads only and will involve an external device, not the newly implanted defibrillator.