How To Use CPT Code 93621

CPT 93621 describes the 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. This article will cover the description, procedure, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information, similar codes and billing examples.

1. What is CPT Code 93621?

CPT 93621 can be used to describe a comprehensive electrophysiologic evaluation procedure. It involves the insertion and repositioning of multiple electrode catheters to induce or attempt to induce arrhythmia. Additionally, left atrial pacing and recording are performed from the coronary sinus or left atrium. This code is used to report the primary procedure and should be used in conjunction with CPT 93620.

2. Official Description

The official description of CPT code 93621 is: ‘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).’ It is important to note that this code should not be reported in conjunction with CPT 93656.

3. Procedure

1. After the initial induction of arrhythmia with pacing and recording of the right side of the heart and bundle of His, the provider inserts an additional catheter through a venous sheath.
2. Under fluoroscopic guidance, the provider moves the catheter through the coronary sinus to the left atrium.
3. Left atrial pacing and recording are then performed through the coronary sinus or left atrium.
4. The provider uses the catheter to transfer electrical signals to the heart tissue, initiating abnormal heart rhythm.
5. The spread of the electrical signal during abnormal heart rhythm is recorded, and the provider attempts to localize the source of the abnormal heart rhythm.
6. Once the pacing and recording are complete, the provider withdraws the catheter and removes the venous sheath.

4. Qualifying circumstances

CPT 93621 is performed when a comprehensive electrophysiologic evaluation is necessary to determine if an arrhythmia or irregular heartbeat is the cause of the patient’s clinical symptoms. The procedure involves the insertion and repositioning of multiple electrode catheters, induction or attempted induction of arrhythmia, and left atrial pacing and recording from the coronary sinus or left atrium. It is important to note that this code should be used in conjunction with CPT 93620.

5. When to use CPT code 93621

CPT code 93621 should be used when a comprehensive electrophysiologic evaluation is performed, including the insertion and repositioning of multiple electrode catheters, induction or attempted induction of arrhythmia, and left atrial pacing and recording from the coronary sinus or left atrium. It is important to use this code in conjunction with CPT 93620.

6. Documentation requirements

To support a claim for CPT 93621, the following documentation is required:

• Indication of the patient’s clinical symptoms and the need for a comprehensive electrophysiologic evaluation
• Description of the procedure performed, including the insertion and repositioning of multiple electrode catheters, induction or attempted induction of arrhythmia, and left atrial pacing and recording from the coronary sinus or left atrium
• Date of the procedure
• Start and end time of the procedure
• Any complications or adverse events that occurred during the procedure
• Signature of the provider performing the procedure

7. Billing guidelines

When billing for CPT 93621, ensure that the procedure includes the insertion and repositioning of multiple electrode catheters, induction or attempted induction of arrhythmia, and left atrial pacing and recording from the coronary sinus or left atrium. This code should be reported in addition to the primary procedure code (CPT 93620). It is important to note that CPT 93621 should not be reported in conjunction with CPT 93656.

8. Historical information

CPT 93621 was added to the Current Procedural Terminology system on January 1, 1990. Since its addition, there have been historical changes to the code. On January 1, 2002, the code description was updated to include right atrial pacing and recording, right ventricular pacing and recording, and His bundle recording. On January 1, 2003, the code description was further updated to specify left atrial recordings from the coronary sinus or left atrium.

9. Examples

1. A patient presents with palpitations and dizziness. The provider performs a comprehensive electrophysiologic evaluation, including the insertion and repositioning of multiple electrode catheters, induction of arrhythmia, and left atrial pacing and recording from the coronary sinus. CPT code 93621 should be reported.