Thanks so much for your answer. This helps my case!
The operative report should document that this was a separate procedure and the reason why. You cannot use these codes for every EP study.
I found this.
Question: Can I report and receive reimbursement for an A-line during a four-wire electrophysiology (EP) study and ablation?
Answer: Yes, if the only catheter the cardiologist places in the arterial access is the monitoring catheter, you can report 36620 (Arterial catheterization or cannulation for sampling, monitoring or transfusion [separate procedure]; percutaneous).
However, you’ll have to prove that the cardiologist performed this service as a separately identifiable procedure and apply modifier -59 (Distinct procedural service) to 36620 to bypass a National Correct Coding Initiative (NCCI) edit.
NCCI bundles this code into EP study codes 93619 (Comprehensive electrophysiologic evaluation with right atrial pacing and recording, right ventricular pacing and recording, His bundle recording, including insertion and repositioning of multiple electrode catheters, without induction or attempted induction of arrhythmia) and 93620 (Comprehensive electrophysiologic evaluation including insertion and repositioning of multiple electrode catheters with induction or attempted induction of arrhythmia; with right atrial pacing and recording, right ventricular pacing and recording, His bundle recording).
You can circumvent the bundle with modifier -59, as long as you show how the cardiologist performed 36620 as a separate service. Because NCCI reasoned this edit as “standards of medical/surgical practice,” you will have to show how 36620 was unrelated to intraoperative monitoring.
Be prepared: Many insurers will view any code with a “separate procedure” descriptor included in the CPT definition to mean that you cannot report this code with any other procedure. That is not true.
Also Dr Z.
ZHealth Online Q&A 2151
Date: Friday, April 02, 2010
Question: Dr. Z, when performing Complete EP study, sometimes we see an arterial access catheter placed to measure and monitor pressures. They are not using this access other than monitoring the pressures. Can we charge 36620 with '59' along with 93620? Please explain. Thank you.
Answer: The NCCI manual states: A number of diagnostic and therapeutic cardiovascular procedures (e.g., CPT codes 92950-92998, 93501-93545, 93600-93624, 93640-93652) routinely utilize intravenous or intra-arterial vascular access, routinely require electrocardiographic monitoring, and frequently require agents administered by injection or infusion techniques. Since these services are integral components of the more comprehensive procedures, codes for routine vascular access, ECG monitoring, and injection/infusion services are not separately reportable. So, If this is not a routine part of the cardiac procedure performed, then 36620 should be reportable as suggested. Dr.z