IVR Intracardiac Echocardiography Procedure

When reviewing operative notes for IVR procedures, it is extremely important that coders understand what is being completed and CPT guidelines about how to accurately report the procedures. Please review the scenario below and pay close attention to the bolded phrases that capture the corresponding CPT procedures.

“Ultrasound guided femoral vein access was performed bilaterally. A 10F and a 7F short sheath were placed on the left side. The intracardiac ultrasound was introduced into the 10F sheath and positioned in the right atrium. Echocardiographic study was performed and was completed a view of the interatrial septum was stabilized for referenced (CPT 93662). 3D electroanatomical mapping was performed using the St Jude Precision mapping system (CPT 93613).

Once all pulmonary veins and left atrial tissue geometry and voltage were collected, the veins were segmented. The HD GRID catheter was placed into each vein of interest. Wide area circumferential ablation was performed over the left and the right pulmonary veins. The posterior wall was isolated by connecting the superior and inferior pulmonary vein WACA lines (CPT 93656). Cardioversion was performed at 200J but was unsuccessful, and therefore a second cardioversion at 360J was performed. This successfully returned the patient to sinus rhythm, but he then developed atrial flutter.  Flutter appeared 2-1 and concentric. The ablation catheter was brought back to the right atrium and a long CTI line was performed at 30 W (CPT 93655). This was greater than 6 cm long line.  Tachycardia cycle length altered during the procedure.  Propagation mapping with the HD GRID in the left atrium showed mitral flutter. Therefore, the ablation catheter was brought back to the left atrium and a long mitral isthmus ablation line was performed at 35 W (CPT 96355).

IV adenosine bolus was administered and pacing from within each pulmonary vein was performed to ensure pulmonary vein exit block and lack of reconnection (CPT 93623).”