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?
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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