jtuominen
Guru
Hi All--
Wondering if anyone has investigated the documentation requirements for the new Cardiac Rhythm Management codes? lately the cath lab here has been entering charges for them during EP Studies, and I feel shaky about the documentation support. What do you think about this one? Here is the Codeset I am thinking of:
93620
93621
93623
93282 (? unsure of documentation giving me enough to assign this.)
Also, Im not planning on charging for the external cardioversion (92960) since primary diagnosis is VT and not afib. Do you agree?
PROCEDURES PERFORMED:
1. Comprehensive EP study with left atrial recording through the
coronary sinus.
2. Repeat EP study with isoproterenol infusion.
3. ICD reprogramming.
INDICATIONS FOR THE PROCEDURE: 69-year-old white male
with a history of coronary artery disease and ventricular tachycardia
status post ICD implant. He is on amiodarone for recurrent VT. The
ICD interrogation showed slow VT of 170 bpm that was not treated.
The known QRS morphology could not be used to exclude SVT. Due to
the nondetection of the arrhythmia and the relatively fast rate, it
was decided to perform an EP study to rule out any slow VT or rapid
SVT.
PROCEDURE AND RESULTS: After the written informed consent was
obtained the patient was transported to CV Lab #4 in the fasting
state. The procedure was performed under local anesthesia and
sterile conditions. Intravenous Versed and fentanyl were used for
conscious sedation. The ICD was programmed without VT/VF detection.
By using the Seldinger technique, a 5 French decapolar catheter was
inserted through the right internal jugular vein and was positioned
into the coronary sinus. (93621) Three quadripolar catheters were inserted
through the right femoral vein and were positioned into the high
right atrium, the His bundle region, and the RV apex.
(93620)
The patient was in normal sinus rhythm. The A-H and H-V intervals
were normal. Ventricular stimulation at the baseline did not show
any V-A conduction. The antegrade A-V node conduction was relatively
poor, with A-V Wenckebach cycle length of about 560 milliseconds. He
clearly had A-H block within the A-V node.
Programmed ventricular extrastimulation induced sustained monomorphic
rapid VT with double extrastimuli. The coupling intervals of
induction were 400/260/240 milliseconds. The VT had a rate of 215
bpm with superior axis and right bundle-branch block. The VT was not
pace-terminable, and the patient lost consciousness before DC
cardioversion. (not going to code 92960 since diagnosis is not afib)
After the DC cardioversion of VT the patient was given isoproterenol
infusion of 2 mcg/min. During isoproterenol infusion repeat
ventricular stimulation showed the appearance of retrograde V-A
conduction through the normal His-Purkinje system. (93623) However, the V-A
conduction was still relatively poor and ventricular extrastimulation
with single extrastimuli did not induce SVT. Subsequently, atrial
extrastimulation was performed by using double and triple
extrastimuli. There was no inducible SVT.
Due to the lack of inducible clinically-relevant tachyarrhythmia, it
was decided not to pursue ablation of the rapid VT. The catheters
and sheaths were removed and local pressure was applied to the
puncture sites. There was no complication.
The patient will continue amiodarone. The ICD has been reprogrammed
with the VT detection rate reduced from 170 bpm to 160 bpm. (93282???)
Wondering if anyone has investigated the documentation requirements for the new Cardiac Rhythm Management codes? lately the cath lab here has been entering charges for them during EP Studies, and I feel shaky about the documentation support. What do you think about this one? Here is the Codeset I am thinking of:
93620
93621
93623
93282 (? unsure of documentation giving me enough to assign this.)
Also, Im not planning on charging for the external cardioversion (92960) since primary diagnosis is VT and not afib. Do you agree?
PROCEDURES PERFORMED:
1. Comprehensive EP study with left atrial recording through the
coronary sinus.
2. Repeat EP study with isoproterenol infusion.
3. ICD reprogramming.
INDICATIONS FOR THE PROCEDURE: 69-year-old white male
with a history of coronary artery disease and ventricular tachycardia
status post ICD implant. He is on amiodarone for recurrent VT. The
ICD interrogation showed slow VT of 170 bpm that was not treated.
The known QRS morphology could not be used to exclude SVT. Due to
the nondetection of the arrhythmia and the relatively fast rate, it
was decided to perform an EP study to rule out any slow VT or rapid
SVT.
PROCEDURE AND RESULTS: After the written informed consent was
obtained the patient was transported to CV Lab #4 in the fasting
state. The procedure was performed under local anesthesia and
sterile conditions. Intravenous Versed and fentanyl were used for
conscious sedation. The ICD was programmed without VT/VF detection.
By using the Seldinger technique, a 5 French decapolar catheter was
inserted through the right internal jugular vein and was positioned
into the coronary sinus. (93621) Three quadripolar catheters were inserted
through the right femoral vein and were positioned into the high
right atrium, the His bundle region, and the RV apex.
(93620)
The patient was in normal sinus rhythm. The A-H and H-V intervals
were normal. Ventricular stimulation at the baseline did not show
any V-A conduction. The antegrade A-V node conduction was relatively
poor, with A-V Wenckebach cycle length of about 560 milliseconds. He
clearly had A-H block within the A-V node.
Programmed ventricular extrastimulation induced sustained monomorphic
rapid VT with double extrastimuli. The coupling intervals of
induction were 400/260/240 milliseconds. The VT had a rate of 215
bpm with superior axis and right bundle-branch block. The VT was not
pace-terminable, and the patient lost consciousness before DC
cardioversion. (not going to code 92960 since diagnosis is not afib)
After the DC cardioversion of VT the patient was given isoproterenol
infusion of 2 mcg/min. During isoproterenol infusion repeat
ventricular stimulation showed the appearance of retrograde V-A
conduction through the normal His-Purkinje system. (93623) However, the V-A
conduction was still relatively poor and ventricular extrastimulation
with single extrastimuli did not induce SVT. Subsequently, atrial
extrastimulation was performed by using double and triple
extrastimuli. There was no inducible SVT.
Due to the lack of inducible clinically-relevant tachyarrhythmia, it
was decided not to pursue ablation of the rapid VT. The catheters
and sheaths were removed and local pressure was applied to the
puncture sites. There was no complication.
The patient will continue amiodarone. The ICD has been reprogrammed
with the VT detection rate reduced from 170 bpm to 160 bpm. (93282???)