Ask Dr. Z

Report documents comprehensive electrophysiology study with coronary sinus catheter. Nowhere is left atrial pacing/recording stated, so I queried provider to make it clear in his report that the CS cath was used to pace/record LA. His response was, "It is always used to record left atrial activity, which is why it is there. It was also used to pace, which is mentioned in the report when we document bidirectional block." Here is the section of the report where bidirectional block is mentioned: "Additional lesions back to the IVC isthmus completed the line with bidirectional block at 125 milliseconds in both directions." Then he goes on to say, "Four ablations were placed near the coronary sinus os without any junctional beats, and mid catheter position without His potential was then applied, which demonstrated excellent junctional tachycardia with intact VA conduction for about 10 seconds and then resumption of normal conduction A-V." I think this is ambiguous and not clear enough to support 93621. Your thoughts and how would you respond to his reply?