Ask Dr. Z

Pt has PSVT and is having a comprehensive EPS and procainamide challenge test done. Which code would be used for the procainamide challenge test during the EPS? Procedure dictation: Via seledinger technique, two wires were placed in the right femoral vein, over which sheaths were used to allow intravascular access. Wires wre placed into the His-Purkinje system and into the right ventricular apex where baseline intervals were obtained. Catheters were later moved into the high right atrium where further electrical stimulation was perfomed. Baseline intervals showed a normal sinus rhythm with a cycle length of 1100 milliseconds. Patient's A-H was 81 with an H-V of 52. Pt was in normal sinus rhythm. Pt's baseline EKG did show RSR prime with mild coving of the ST segment in V1 and V2with ST segment elevation. Procainamide was initiated and a total dose of 750 mg was given. This was given over a 20 minute period with EKG's being followed on every 3-4 minute basis. A final EKG was done following a total dose of procainamide. These were all unchanged from patient's baseline. A ventricular stimulation study was then performed with evidence of ventricular and atrial retrograde conduction and a V-A block cycle length of 540 milliseconds..... Would code 93623 be appropriate for the procainamide challenge test or would it be considered part of the comprehensive EPS and not charged separately?? Your assistance is greatly appreciated Thank you.