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Webinar Insights: Coding Electrophysiological Study (EPS)

By AGS Health

July 6, 2023

AGS Health recently held a webinar about coding EP studies . Below is a snippet of that webinar. We encourage you to watch the webinar in its entirety to discover even more valuable content than what we have provided here.

What is an EP Study?

Coding Electrophysiological Study

The proper heart rhythm is critical for good health. Every time the heart beats, electrical signals travel through the heart. These signals cause different parts of the heart to expand and contract.

The heart muscle creates the electrical impulse at the sino-atrial node (SA node), which then travels down the atria to the atrioventricular node (AV node), which monitors, adjusts, and distributes the electrical impulses down the bundle of His.

This directs the left and right bundles leading to the Purkinje fibers, which go to both ventricles to allow overall synchronization contraction of the atria and ventricles.

Purpose of an EP Study

EP procedures identify the source of cardiac arrhythmias and treat these arrhythmias with a variety of methods. It is also used to determine if a patient is at risk of sudden death. The key purpose is to identify and treat arrhythmias.

When the conduction of electrical activity is not synchronized due to the normal pathways being interrupted by infarct and scarring, irregular and asynchronous electrical conduction can occur.

New pathways are created over time (circuits), and abnormal heart rhythms like atrial fibrillation, atrial flutter, supraventricular tachyarrhythmia (SVT), ventricular tachycardia (VT), etc. may occur.

Recording and mapping the conduction system allows physicians to identify any conduction abnormalities causing arrhythmia and determine the appropriate treatment. The treatment is often the interruption of the abnormal pathway by ablating the pathway with radiofrequency (heat) or cryo (cool) ablation catheters.

Diagnostic Procedures

To identify abnormal pathways in the heart, one or more specialized catheters are placed in different locations throughout the right side of the heart and coronary sinus and, less commonly, directly into the left atrium or ventricle.

The diagnostic catheters have electrodes that allow stimulation and recording of the cardiac electrical impulses down its pathway.

Programmed electrical stimulation is performed in the heart to induce an arrhythmia so its source can be identified or to test the effectiveness of different medications to control the arrhythmia. This is called pacing.

The arrhythmia is then recorded for evaluation of the speed and type of arrhythmia. The arrhythmia is sometimes mapped to determine the exact location where the errant impulses start and the path they follow. This is performed by specialized catheters and equipment.

Coding EP Studies

Most EP studies involve pacing and recording the electrical pathways in the right ventricle and the right atrium and recording the electrical pathway in the bundle of His. All of these activities are described by two different codes:

93619 – Comprehensive electrophysiologic evaluation with right atrial pacing and recording, right ventricular pacing and recording, His bundle recording, including insertion and repositioning of multiple electrode catheters, without induction or attempted induction of arrhythmia

93620 – Comprehensive electrophysiologic evaluation including insertion and repositioning of multiple electrode catheters with induction or attempted induction of arrhythmia; with right atrial pacing and recording, right ventricular pacing and recording, His bundle recording

The only difference between the codes is the induction or attempted induction of arrhythmia.

For examples of case studies, please review the AGS Webinar

Comprehensive Procedure Addons

There are instances when diagnostics are performed in other areas of the heart.

93621 – Comprehensive electrophysiologic evaluation including insertion and repositioning of multiple electrode catheters with induction or attempted induction of arrhythmia; with left atrial pacing and recording from coronary sinus or left atrium (List separately in addition to code for primary procedure). This code may be reported in addition to code 93620.

93622– Comprehensive electrophysiologic evaluation including insertion and repositioning of multiple electrode catheters with induction or attempted induction of arrhythmia; with left ventricular pacing and recording (List separately in addition to code for primary procedure). This code may be reported in addition to code 93620, 93653, and 93656.

Watch the Webinar for More

The webinar goes on to share more about how to code for:

  • Stimulation and pacing after drug infusion
  • Mapping
  • Individual Studies
  • Intracardia Echography
  • Ablation of Electrical pathways
  • Supraventricular Ablation
  • Pulmonary Vein Ablation
  • Ventricular Tachycardia Ablation

Conclusion: Staying Current is Essential

Coding is complex, and changes add to the challenges. Being familiar with the CPT changes is important so medical coders don’t overcode or undercode. We encourage you to watch the webinar so you better understand CPT codes for EP studies, and you can be confident that your provider gets the proper reimbursement.

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AGS Health

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AGS Health is more than a revenue cycle management company—we’re a strategic partner for growth. Our distinctive methodology blends award-winning services with intelligent automation and high-touch customer support to deliver peak end-to-end revenue cycle performance and an empowering patient financial experience.

We employ a team of 12,000 highly trained and college-educated RCM experts who directly support more than 150 customers spanning a variety of care settings and specialties, including nearly 50% of the 20 most prominent U.S. hospitals and 40% of the nation’s 10 largest health systems. Our thoughtfully crafted RCM solutions deliver measurable revenue growth and retention, enabling customers to achieve the revenue to realize their vision.

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