Jane5711
Networker
Good morning! One of our EP providers would like to charge the following CPT codes for the below referenced op report:
93660, 26
36620
33282
Our coding team has a problem billing for 36620 however our Provider seems to think that we can. Any advice would be appreciated
PROCEDURES PERFORMED:
1. Head-up tilt test with intra-arterial hemodynamic monitoring with and
without isoproterenol provocation.
2. Implantation of an implantable loop recorder.
INDICATION: Syncope.
POSTOPERATIVE DIAGNOSES:
1. No evidence of neurocardiogenic syncope except as exemplified by a lack
of vasodepressor and cardioinhibitory response to passive head-up tilt
test as well as with isoproterenol provocation.
2. No evidence of carotid sinus hypersensitivity.
3. Successful implantation of an implantable loop recorder.
PROCEDURE IN DETAIL: The patient was brought to electrophysiology laboratory
in a fasting postabsorptive state. Informed and written consent was obtained.
After performing the appropriate time-out, the patient was placed on a head-up
tilt table. Baseline recordings were obtained. An intra-arterial hemodynamic
catheter was placed in the left radial artery for invasive hemodynamic
monitoring.
FINDINGS: Baseline recordings: Blood pressure is 147/81 with a heart rate of
72, oxygen saturation was 96%. The patient was in a normal sinus rhythm.
After approximately 20 minutes passive lying in supine position, the patient
was raised to 70 degree head-up tilt, where continued monitoring was
performed. After 45 minutes of passive head-up tilt test, there was no
evidence of vasodepressor or cardioinhibitory response noted.
Isoproterenol provocation: Following a 45-minute passive head-up tilt,
isoproterenol was subsequently infused to 1 mcg/minute. Continued monitoring
was continued. Heart rate increased to approximately 121 beats per minute.
Again, there was no evidence of vasodepressor or cardioinhibitory response
noted after 20 minutes of isoproterenol provocation. The patient subsequently
was returned back to supine position and isoproterenol was discontinued.
Response to carotid sinus pressure: After the patient returned back to normal
hemodynamics, carotid sinus pressure was performed bilaterally, which
demonstrated no evidence of carotid sinus hypersensitivity.
Implantation of implantable loop recorder: After prepping and draping in the
usual sterile fashion, 1% bupivacaine was infiltrated into the 4th intercostal
space, left parasternal border. Utilizing an insertion tool, a Medtronic LINQ
implantable loop recorder was subsequently inserted into the subcutaneous
location. Adequate sensing was noted from the device. Steri-Strips and
pressure dressing were applied.
The patient tolerated the procedure without any complications.
IMPRESSION:
1. No evidence of neurocardiogenic syncope as exemplified by lack of
vasodepressor and cardioinhibitory response both in the baseline state as
well as with isoproterenol.
2. No evidence of carotid sinus hypersensitivity.
3. Successful implantation of implantable loop recorder.
Many thanks,
Jane
93660, 26
36620
33282
Our coding team has a problem billing for 36620 however our Provider seems to think that we can. Any advice would be appreciated
PROCEDURES PERFORMED:
1. Head-up tilt test with intra-arterial hemodynamic monitoring with and
without isoproterenol provocation.
2. Implantation of an implantable loop recorder.
INDICATION: Syncope.
POSTOPERATIVE DIAGNOSES:
1. No evidence of neurocardiogenic syncope except as exemplified by a lack
of vasodepressor and cardioinhibitory response to passive head-up tilt
test as well as with isoproterenol provocation.
2. No evidence of carotid sinus hypersensitivity.
3. Successful implantation of an implantable loop recorder.
PROCEDURE IN DETAIL: The patient was brought to electrophysiology laboratory
in a fasting postabsorptive state. Informed and written consent was obtained.
After performing the appropriate time-out, the patient was placed on a head-up
tilt table. Baseline recordings were obtained. An intra-arterial hemodynamic
catheter was placed in the left radial artery for invasive hemodynamic
monitoring.
FINDINGS: Baseline recordings: Blood pressure is 147/81 with a heart rate of
72, oxygen saturation was 96%. The patient was in a normal sinus rhythm.
After approximately 20 minutes passive lying in supine position, the patient
was raised to 70 degree head-up tilt, where continued monitoring was
performed. After 45 minutes of passive head-up tilt test, there was no
evidence of vasodepressor or cardioinhibitory response noted.
Isoproterenol provocation: Following a 45-minute passive head-up tilt,
isoproterenol was subsequently infused to 1 mcg/minute. Continued monitoring
was continued. Heart rate increased to approximately 121 beats per minute.
Again, there was no evidence of vasodepressor or cardioinhibitory response
noted after 20 minutes of isoproterenol provocation. The patient subsequently
was returned back to supine position and isoproterenol was discontinued.
Response to carotid sinus pressure: After the patient returned back to normal
hemodynamics, carotid sinus pressure was performed bilaterally, which
demonstrated no evidence of carotid sinus hypersensitivity.
Implantation of implantable loop recorder: After prepping and draping in the
usual sterile fashion, 1% bupivacaine was infiltrated into the 4th intercostal
space, left parasternal border. Utilizing an insertion tool, a Medtronic LINQ
implantable loop recorder was subsequently inserted into the subcutaneous
location. Adequate sensing was noted from the device. Steri-Strips and
pressure dressing were applied.
The patient tolerated the procedure without any complications.
IMPRESSION:
1. No evidence of neurocardiogenic syncope as exemplified by lack of
vasodepressor and cardioinhibitory response both in the baseline state as
well as with isoproterenol.
2. No evidence of carotid sinus hypersensitivity.
3. Successful implantation of implantable loop recorder.
Many thanks,
Jane