karbaker
Guest
CARDIOVASCULAR REPORT
BASIC EP STUDY AND AV NODE ABLATION.
DATE OF SERVICE: 09/16/2013
INDICATION: This is an 84-year-old gentleman.
because the patient has multiple AICD shocks. He had
7 ICD shocks with 36 joules and 40 joules and it failed.
The patient was admitted to the intensive care unit at Delano Hospital,
although it appeared the ICD interrogation could be the atrial
tachyarrhythmia and atrial flutter or atrial tachycardia causing left
ventricular response, but the rate was in the range of VT and VF, and
therefore, the patient received multiple AICD shocks and that could be
the reason why the defibrillator was unable to cardiovert atrial
arrhythmia.
PROCEDURE PERFORMED: The patient was brought to the EP lab and
connected to the monitors. As usual prepped and draped in a sterile
aseptic technique, and a 6-French vascular sheath has been advanced to
the right common femoral vein. An 8-French vascular sheath has been
advanced to the right common femoral vein. SRO sheath had been
exchanged over the long wires and SRO sheath placed to the right atrium
and also the Cournand catheter has been advanced under fluoroscopic
guidance and placed to the His bundle positions. Then the patient under
fluoroscopic guidance as well as the the positions of the CS
ostium was located.
The patient underwent radiofrequency ablations of theAVN and
the ICD had been programmed initially VOO _at the rate of 40.
During the ablation, the heart rate was found to be pacemaker dependent
and patient tolerated the procedure well. No immediate complications.
FINDINGS: The interval prior to the procedure was 832 msec, QRS
duration 187, QT interval 465, and HV interval was around 50 msec and PR
interval 164 msec. After the AV node, the patient's AICD has been
programed to lower rate limit 80 A paced, B paced.
Then we proceeded with upper limit vulnerability test later on. The
patient tolerated the procedure well with no immediate complication.
IMPRESSION: Successful AV node ablation, successful 3D mapping under
fluoroscopic guidance and basic EP study. The patient tolerated the
procedure well with no immediate complication.
coded:
93619,26 denial bundled to 93641
93650, 59
93541, 26,59
93613, 59 denial as add on, primary code not billed
Can anyone review and assist, what did we do wrong, I think the 93613 shoudl not of been coded but find no other error.
thank you in advance
Karen
BASIC EP STUDY AND AV NODE ABLATION.
DATE OF SERVICE: 09/16/2013
INDICATION: This is an 84-year-old gentleman.
because the patient has multiple AICD shocks. He had
7 ICD shocks with 36 joules and 40 joules and it failed.
The patient was admitted to the intensive care unit at Delano Hospital,
although it appeared the ICD interrogation could be the atrial
tachyarrhythmia and atrial flutter or atrial tachycardia causing left
ventricular response, but the rate was in the range of VT and VF, and
therefore, the patient received multiple AICD shocks and that could be
the reason why the defibrillator was unable to cardiovert atrial
arrhythmia.
PROCEDURE PERFORMED: The patient was brought to the EP lab and
connected to the monitors. As usual prepped and draped in a sterile
aseptic technique, and a 6-French vascular sheath has been advanced to
the right common femoral vein. An 8-French vascular sheath has been
advanced to the right common femoral vein. SRO sheath had been
exchanged over the long wires and SRO sheath placed to the right atrium
and also the Cournand catheter has been advanced under fluoroscopic
guidance and placed to the His bundle positions. Then the patient under
fluoroscopic guidance as well as the the positions of the CS
ostium was located.
The patient underwent radiofrequency ablations of theAVN and
the ICD had been programmed initially VOO _at the rate of 40.
During the ablation, the heart rate was found to be pacemaker dependent
and patient tolerated the procedure well. No immediate complications.
FINDINGS: The interval prior to the procedure was 832 msec, QRS
duration 187, QT interval 465, and HV interval was around 50 msec and PR
interval 164 msec. After the AV node, the patient's AICD has been
programed to lower rate limit 80 A paced, B paced.
Then we proceeded with upper limit vulnerability test later on. The
patient tolerated the procedure well with no immediate complication.
IMPRESSION: Successful AV node ablation, successful 3D mapping under
fluoroscopic guidance and basic EP study. The patient tolerated the
procedure well with no immediate complication.
coded:
93619,26 denial bundled to 93641
93650, 59
93541, 26,59
93613, 59 denial as add on, primary code not billed
Can anyone review and assist, what did we do wrong, I think the 93613 shoudl not of been coded but find no other error.
thank you in advance
Karen