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Thread: EP what would you code?

  1. #1

    Default EP what would you code?

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    The patient was connected to the monitor, and continuous ECG
    recordings were made. We decided to wait for spontaneous ectopy
    before proceeding with instrumentation. There was absolutely no
    ectopy whatsoever at baseline. Isoproterenol then was administered
    starting at 2 mcg/min and was gradually incremented to 5 mcg/min.
    With that, the patient developed sinus tachycardia into the 120s as
    well as shaking that became quite intense. The atenolol was stopped.
    There was no ventricular ectopy during the washout of isoproterenol.

    Phenylephrine bolus was then administered. The patient inadvertently
    received a higher then intended (100 mcg) dose of phenylephrine. He
    developed a sharp severe headache that lasted approximately 2-3
    minutes. His systolic blood pressure became markedly elevated and
    appeared to exceed 200 mmHg. Versed, fentanyl and IV metoprolol were
    administered, and within minutes the headache subsided and his blood
    pressure returned to normal.

    There was no ventricular ectopy elicited in response to the
    phenylephrine bolus. During 75 minutes of electrocardiographic
    monitoring, there was no ventricular ectopy whatsoever. At that time
    we decided not to proceed with instrumentation.

    DISCUSSION: Unfortunately, ventricular ectopy was
    completely quiescent today. There was not a single clinical PVC that
    was seen in 75 minutes of monitoring. Given the failure of diltiazem
    and a beta blocker in the past to control his palpitation, one
    may consider a trial of low dose antiarrhythmic drug therapy such as
    sotalol or a Class 1C agent (flecainide or propafenone). This will
    be further discussed with the patient today.

    1. There was no spontaneous or inducible (with drug infusion)
    ventricular ectopy to guide mapping and ablation.
    2. Inadvertent administration of higher than intended dose of
    phenylephrine that caused elevation of systolic blood pressure and a
    transient headache. This resolved prior to the patient leaving the
    electrophysiology laboratory.

  2. #2
    Join Date
    Apr 2007


    Hi there--

    This is a weird one. Based on what's provided I would think about doing one of two things:

    1. Since this sounds like it really ended up just being a drug study, 93623 can't be chosen since you didn't do a comprehensive EP study. But what I might try to swing instead is the unlisted procedure code 93799 and send with report.
    2. If the MD described the intended procedure at the top of his report, and let's say his intension was to do a RV single site EP study only, maybe bill 93603-53 (PC)/ 74 (TC). I wouldn't bill 93612 in addition to 93603 in this case. If he planned to do a comp EP, 93620 - 53/74. Also, I would only feel comfortable doing this if the MD also described the insertion of his diagnostic EP catheter(s).

    Tricky one, good luck. Maybe other suggestions out there?

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