Health Information Management

Q/A: When do we use modifier -52 with the new electrophysiology ablation codes?

APCs Insider, February 22, 2013

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Q: Our cardiac catheter lab performs electrophysiology (EP) studies/ablation procedures, but our physicians do not always pace/record all three sites with the ablation. The arrhythmia is induced prior to all three sites being paced/recorded and the ablation is performed. 

The descriptions of the CPT codes 93653 and 93654 specifically state:  “with induction or attempted induction of an arrhythmia with right atrial pacing and recording, right ventricular pacing and recording, HIS recording….”

Should we appendmodifier -52 to indicate reduced services?

A: The question concerning application of modifier -52 in situations where physicians induced arrhythmia without fulfilling all three components described in the CPT definition has been raised with the professional societies (American College of Cardiology, Heart Rhythm Society). 
According to the information we received, physician advisors representing these professional societies do not believe it is appropriate to append a reduced-services modifier if all three components in these situations.  The information also noted that specific clarification regarding the reporting of these services/codes will be provided through an upcoming CPT Assistant.


Editor’s note: Denise Williams, RN, CPC-H, vice president of revenue integrity services at Health Revenue Assurance Associates, Inc., in Plantation, Fla., answered this question.

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