Test Yourself:
A Comprehensive EPS Report Example
Published on Tue Apr 01, 2003
Practice your comprehensive EPS coding skills by supplying codes for the following scenario adapted from an actual EPS operative note. Then look at the box below to compare your answers with a coding expert's response:
The patient arrived in the electrophysiology laboratory. All sheaths and catheters were inserted percutaneously using the Seldinger technique under conscious sedation with Propofol. The right clavicular region, right groin, and left groin were prepped and draped in the usual manner.
The physician inserted a 4# French arterial sheath into the right femoral artery for monitoring blood pressure and arterial gases. The physician inserted a 7# French deflectable catheter with 20 electrodes arranged in close bipolar pairs into the right subclavian vein and advanced into the coronary sinus and great cardiac vein.
The physician next inserted a 7# French deflectable catheter with 20 electrodes arranged in close bipolar pairs into the right femoral vein and positioned along the crista terminalis, with the tip of the catheter positioned at the ostium of the superior vena cava. He inserted a 7# French octapolar electrode catheter (2-mm spacing) into the left femoral vein and advanced it to the His bundle region. Then the physician inserted a 6# French hexapolar electrode catheter into the left femoral vein and advanced to the right atrial appendage. He next inserted a 7# French quadrapolar electrode catheter into the left femoral vein and advanced to the right ventricular base close to the His bundle for ventricular pacing.
The physician used a 7.5# French deflectable quadrapolar catheter with a 4-mm irrigated tip electrode and location sensor for the Biosense mapping system, which was inserted into the right femoral vein for right atrial mapping. The patient was awakened to allow induction of tachycardia. The physician induced five macroreentrant right atrial tachycardias. Afterward, he induced programmed atrial stimulation, AT#3, which had a cycle length of 345 msec.
Answer: 1. Report 93620 because the physician inserted and repositioned multiple electrode catheters, induced arrhythmia, and performed right atrial pacing and recording, right ventricular pacing and recording, and His bundle recording.
2. Add 93621 to 93620 for the pacing and recording from the coronary sinus and great cardiac vein.
3. Add 93613 to 93620 for the Biosense (3-D) mapping of the right atrium.
4. You would not add 93623 to 93620 because the report does not document administration of an IV medication such as Isuprel for programmed stimulation during attempted arrhythmia induction.
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