Health Information Management

Q&A: When can we use CPT code 93623 with electrophysiology studies?

APCs Insider, June 13, 2014

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Q: We perform electrophysiology (EP) studies in our catheterization lab for outpatients. Many times this involves infusing a drug and then stimulating and pacing the heart. We also do this with our cardiac ablation procedure. We have been reporting CPT® code 93623 (programmed stimulation and pacing after intravenous drug infusion [list separately in addition to code for primary procedure]) in both scenarios, with modifier -59 (distinct procedural service), if required. However, our new catheterization lab director has told us to stop doing this, as CPT 93623 is included. Is he correct?
A: Yes and no. CPT 93623 is an add-on code. A parenthetical note in the CPT Manual specifies which codes 93623 may be paired with. 
Based on this information and specific instructions in the National Correct Coding Initiative (NCCI) Manual, 93623 may be reported with the EP study codes because in this scenario, the procedure is diagnostic in nature. However, the code should not be reported with the cardiac ablation codes because the purpose of the procedure is to confirm the success of the ablation procedure. Confirmation of the success of the ablation is part of the ablation procedure.
According to the NCCI manual, chapter 11:
CPT code 93623 (programmed stimulation and pacing after intravenous drug infusion) is an add-on code that may be reported per CPT Manual instructions only with CPT codes 93610, 93612, 93619, 93620, or 93653-93656. Although CPT code 93623 may be reported for intravenous drug infusion for diagnostic programmed stimulation and pacing, it should not be reported for injections drug with stimulation and pacing following an intracardiac catheter ablation procedure (e.g., CPT codes 93650-93657) to confirm adequacy of the ablation. Confirmation of the adequacy ablation is included in the intracardiac catheter ablation procedure.
Editor’s note: Denise Williams, RN, CPC-H, vice president of revenue integrity services at Health Revenue Assurance Associates, Inc., in Plantation, Florida, answered this question.

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