Ask Dr. Z

Would you recommend codes 93653 and 93655 for this procedure? "We measured baseline intervals. We then performed atrial extrastimulus testing as well as incremental pacing. There was dual AV nodal physiology with induction of short RP less than 70 millisecond tachycardia. His refractory PVCs did not pull in the a. his refractory PACs delayed the next his ruling out junctional tachycardia. Ventricular overdrive pacing resulted in VA treat response ruling out atrial tachycardia. We then used a irrigated force catheter to perform right slow pathway modification with powers of 25 w. There were good junctional beats with 1-1 retrograde conduction. We then repeated programmed electrical stimulation with doubles from the high right atrium and from the coronary sinus with and without Isuprel up to 0.04 mcg per kg per minute. There was single jump without any echoes. In the process of programmed electrical stimulation we induced typical atrial flutter. Entrainment confirmed that it was caval tricuspid isthmus dependent flutter. Ablation was performed across the caval tricuspid isthmus that terminated the flutter."