Cardiology Coding Alert

Question: Can you please help me with this scenario? I’m looking at code +93623, but I’m not sure if that is correct: The cardiologist performed a procainamide infusion study. Both the pre- and post-procedure diagnoses were cardiac arrest. The patient gave informed consent for the electrophysiology (EP) study, transseptal catheterization, coronary angiography, epicardial access, and RF ablation, after comprehending the risks, benefits, indications, and alternatives.

Procedure: During the procedure, the cardiologist brought the patient into the EP lab and hooked up to a 12-lead electrocardiography (ECG) machine. The cardiologist obtained a baseline ECG, with no evidence of a Type I Brugada pattern noted. Next, the cardiologist infused procainamide 839 mg (10mg/kg) over 30 minutes and performed a repeat ECG every 10 minutes. The cardiologist continuously monitored the patient’s blood pressure (BP) and heart rate (HR). At the end of 60 minutes, the cardiologist did not see a pattern of Type I Brugada. The cardiologist observes the patient another 30 minutes and performed three more ECGs in holding after that. The cardiologist did not note arrhythmias or repolarization abnormalities at any time. The cardiologist concluded that no Type I Brugada pattern was involved with procainamide infusion. The prior cardiac arrest was likely due to hypoxia and infection, not Brugada. There were no complications with this procedure. The patient was discharged home in stable condition with instructions to follow up with the cardiologist as an outpatient and to continue his current medications.

Ohio Subscriber

Answer: First, you cannot report +93623 (Programmed stimulation and pacing after intravenous drug infusion (List separately in addition to code for primary procedure)) as a stand-alone code because it is an add-on code, so it requires a primary code.

In this instance, the medical documentation indicates an EP study; however, your cardiologist did not place catheters in the ventricles, atria, or bundle of HIS, so this procedure would not qualify for codes 93600 (Bundle of His recording)-+93662 (Intracardiac echocardiography during therapeutic/diagnostic intervention, including imaging supervision and interpretation (List separately in addition to code for primary procedure)). What your cardiologist has performed is called a Procainamide challenge. During the procedure, the cardiologist is trying to see if the patient has something called Brugada syndrome, which is a genetic disorder that causes the heart muscles to handle sodium abnormally and leads to dangerous arrhythmia as a result. During this procedure, the patient receives an infusion of procainamide medication under the supervision of the physician, which is intended to try to induce Brugada pattern on an EKG. Once the medication is infused, EKGs are performed every 10 minutes. The American Medical Association (AMA) has recommended that a provider should bill unlisted code 93799 (Unlisted cardiovascular service or procedure) for this procedure. Also, because this procedure is usually performed in the facility, the provider would not bill for the drug supply for the procainamide.