The intent was VT ablation, Due to the inability to induce, despite stim/burst pacing and giving prel, the case was concluded.
can i modify the 93654 with a 52 or 53 , (in addition bill 93662, 93623)
OR can this be billed 93620 93623 (with ICE not billable)?
thanks in advance.
Intra-cardiac echocardiography (ICE)
There was no pericardial effusion at baseline and none at the end of the case with no change. ICE was used to confirm catheter placement around intracardiac structures and create a Sound Shell anatomy of the aortic root, RA structures, and right ventricle
PVC Ablation
There were 4 rare PVCs.
PVC1: RBRI, positive across precordium
PVC2: RBLI, positive across precordium
PVC3: LBRI, transition V6
PVC4: LBLI, transition V3
Despite isuprel up to 10mcg/min with sinus rate to 120, PVCs were too infrequent to map.
A quadripolar catheter in the RV was used to attempt VT induction with isuprel with RV apical stimulation trains of 600ms and 400ms up to triple extrastimuli down to VERP without inducible VT. RV burst pacing down to 290ms failed to induce VT.
Given multiform PVCs too rare to map along with no LGE on CMR and no inducible VT, we did not perform further ablation or mapping.
ICD therapies were then returned to original and lead parameters were stable.
can i modify the 93654 with a 52 or 53 , (in addition bill 93662, 93623)
OR can this be billed 93620 93623 (with ICE not billable)?
thanks in advance.
Intra-cardiac echocardiography (ICE)
There was no pericardial effusion at baseline and none at the end of the case with no change. ICE was used to confirm catheter placement around intracardiac structures and create a Sound Shell anatomy of the aortic root, RA structures, and right ventricle
PVC Ablation
There were 4 rare PVCs.
PVC1: RBRI, positive across precordium
PVC2: RBLI, positive across precordium
PVC3: LBRI, transition V6
PVC4: LBLI, transition V3
Despite isuprel up to 10mcg/min with sinus rate to 120, PVCs were too infrequent to map.
A quadripolar catheter in the RV was used to attempt VT induction with isuprel with RV apical stimulation trains of 600ms and 400ms up to triple extrastimuli down to VERP without inducible VT. RV burst pacing down to 290ms failed to induce VT.
Given multiform PVCs too rare to map along with no LGE on CMR and no inducible VT, we did not perform further ablation or mapping.
ICD therapies were then returned to original and lead parameters were stable.