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CRM Code 93282 during a EP Study

  1. #1
    Wink CRM Code 93282 during a EP Study
    Medical Coding Books
    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:
    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?

    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

    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.
    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
    (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.

  2. Default
    Hey there,

    I agree with your code set. I would bill for the cardioversion. Since the pt lost consciousness it was medically necessary to perform the cardioversion and this is clearly supported in the report. I agree with you about 93282, not enough info provided. It seems like there should be something more documented. The doc doesn't indicate that he went through the adjustments Can you have the doc do an addendum?

    Dolores, CPC, CCC

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