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Thread: EP Study Help

  1. #1
    Join Date
    Apr 2007
    Kansas City, MO

    Default EP Study Help

    AAPC: Back to School
    We are needing help in coding this procedure note. We aren't sure if we should bill
    93620(with or withou mod -52), 93621, & 93651
    93620 & 93651
    or is there another set codes we should be using?

    Here is the note:

    PROCEDURE: Complete electrophysiology study including coronary sinus recording and radiofrequency ablation of right atrial flutter.

    INDICATION: Patient with recurrent episodes of typical right atrial flutter-looking rhythm.

    DESCRIPTION OF PROCEDURE: Following acquisition of informed consent, the patient was taken to the electrophysiology laboratory where his right groin region was sterilely prepped and draped. He was given IV Versed and IV fentanyl to achieve sedation. Lidocain 1% was used to anesthetize the skin and subcutaneous tissues overlying the right femoral vein.

    The vein was cannulated using the usual Seldinger technique and 2 introducer sheaths were placed into the right femoral vein. Via these introducers, 2 multipolar electrophysiology catheters were passed and initially positioned around the tricuspid valve annulus into the coronary sinus and in the region of the His bundle. Baseline rhythm was sinus with a sinus cycle length of 880 msec, a PR interval of 187 msec, QRS of 95 msec, QU interval of 400 msec, A-H interval 107 msec and his H-V interval was 47 msec.

    The His bundle catheter was a steerable 8-mm tipped ablation catheter. This was positioned to deliver a series of burns from the tricuspid valve annulus to the inferior vena cava. After our first run of burns it did not appear that we achieved any conduction block, so the short introducer sheath was exchanged for a long Ramp-1 sheath. With this better tissue contact seemed to be obtained and again a series of burns was delivered. At this point, we tested for conduction block. Pacing was done from the coronary sinus ostium and this and using the electrograms with the tricuspid valve annulus catheter, it did appear that a line of conduction block had been obtained. The conduction time from the coronary sinus ostium to just passed the line of block was 165 msec. He was observed and did not appear to regain any conduction across this area of burns. At this point, it was felt that he had a successful right atrial flutter ablation. The catheters were removed. The sheaths pulled from the groin, manual pressure applied to the puncture site, and an appropriate dressing was applied.

    He tolerated the procedure well. There were no immediate complications. He was admitted to telemetry in stable condition.

    Thanks in advance for your help!

  2. #2


    The 93620 & 93651 would be correct.

    Dawn CPC, CCC

  3. #3
    Join Date
    Apr 2007
    Kansas City, MO


    Thanks for your response!!

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