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Help Please - premature ventricular

  1. Default Help Please - premature ventricular
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    What would you code? Thanks

    PROCEDURE: Isuprel challenge.

    PRE-PROCEDURE DIAGNOSIS: Symptomatic premature ventricular

    The patient was referred for a potential EP study and ablation should she
    have an increased amount of premature ventricular contractions.
    DESCRIPTION OF PROCEDURE: The patient was observed on the table with
    12-lead EKG. She had a few premature ventricular contractions
    consistent with a left bundle branch inferior axis with the
    transition in lead V3 and no subsequent premature ventricular
    contractions. Therefore Isuprel was given up to 10 mcg/minute.
    During Isuprel infusion and washout the patient had several different
    types of premature ventricular contraction morphology, but none of
    these appeared to be clinical.

    PLAN: Given the above findings there is no need to continue with the
    procedure. The best hope will be pace mapping. However, even this
    treatment will yield only a
    50% success rate. The clinical premature ventricular contraction
    appears on the left side, and therefore the risks of continuing the
    procedure probably outweigh the benefits. We decided not to proceed.

    CONCLUSION: There were a few isolated premature ventricular
    contractions noted before starting the case. Despite the high dose
    of Isuprel infusion and with exercise the patient s premature
    ventricular contraction burden did not increase. Therefore there did
    not appear to be a need to proceed with the procedure. The patient
    will be prescribed a trial of Verapamil 120 mg a day.

  2. Question drug challenge
    There has been confusion over this senario. Not a clear cut answer but here are a couple of options.

    A patient was prepped for an EP study and a 12-lead study showed (whatever) the decision was made to give IV isoprel. There are two coding options: Report the infusion, or use code 93620 with a discontinued modifier (53/73).

    These are the only two ways i know to report this case. I would be interested to know how other coders would report this.


  3. #3
    I don't have any documentation on this-- but what about a 12 Lead EKG code 93005/93010 and what about an infusion code? 96365 maybe?

    96365 Intravenous infusion, for therapy, prophylaxis, or diagnosis (specify substance or drug); initial, up to 1 hour

  4. Default
    Thanks no. 1

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