It's tough to tell from the limited information, but did your physician perform an electrophysiologic study (93619 or 93620)? These codes also serve as valid primary codes for add on 93623 and include "induction or arrhythmia" or "attempted induction of arrhythmia" (which is essentially what happened here). If the physician documented other details to support one of these codes (placement of catheters with pacing and recording from the sites required), I would pair either 93619 or 93620 with 93623. If he truly only performed the 93623 and then terminated which would be rare, you could consider an unlisted code instead since the add on won't be paid without a valid primary CPT.
I hope that helps -have a good night!
Kim
www.codingmastery.com
This is the providers note: hope this helps
PROCEDURE PERFORMED:
Programmed stimulation and pacing after IV drug infusion isoproterenol.
PREOPERATIVE DIAGNOSIS:
Premature ventricular contraction.
POSTOPERATIVE DIAGNOSIS:
Premature ventricular contraction.
COMPLICATIONS:
None.
SPECIMEN TAKEN:
None.
ESTIMATED BLOOD LOSS:
Zero.
CONTRAST:
Zero.
SEDATION:
None.
BRIEF SYNOPSIS:
Mr. xxx is a 76-year-old gentleman with past medical history of
coronary artery disease, prior bypass, first-degree AV block, ischemic
cardiomyopathy, congestive heart failure, Medtronic dual-chamber ICD. He was
noted on outpatient Holter monitor to have 30% PVC burden. He is seen,
examined and deemed appropriate for EP study and PVC ablation.
DESCRIPTION OF PROCEDURE:
The patient was brought to the EP lab in a fasting state, whereupon he was
connected to blood pressure, pulse oximetry and electrocardiographic
monitoring. He presented in sinus rhythm. At baseline, he had complete
suppression of his PVCs.
Sinus cycle length was 1200 milliseconds, PR 186, QRS 118, QT 460.
He had a single PVC, which carried a right bundle-branch morphology and
transition between leads V5 and V6. The access was superior and it was
positive in lead 1, AVR and aVL.
I then initiated isoproterenol up to 30 mcg. On isoproterenol, sinus cycle
length was 1000 milliseconds, PR 179, QRS 125, QT 440. During Isuprel, there
were no inducible PVCs. Following the washout phase of Isuprel, there was
another PVC, however, PVC #2 carried a different morphology. It had a right
bundle morphology and transition at V5. The access was inferior and negative
in lead 1 and aVL. It was biphasic in lead aVR.
Due to the paucity of PVCs as well as his inability to be induced with
isoproterenol, we decided not to pursue ablation.