Ask Dr. Z

Is it always necessary to do mapping prior to the SVT ablation? I was told that even if the mapping isn't stated in the dictation, it is always required so I should code it. I disagree with this. Below is a dictation that I don't see "mapping" but was asked to add the 93609. The codes I used are 93620, 93621, 93462, 93651. PROCEDURE: This patient with a history of recurrent, symptomatic PSVT was brought in for an electrophysiologic study and/or ablation. The patient presented to the EP laboratory in sinus rhythm. Catheters were placed in the right atrium, His-position, coronary sinus, and right ventricle for pacing and recording. Baseline measurements were recorded. During PSVT, the fastest tachycardia cycle length was 380ms with eccentric atrial activation (CS 3-4 was earliest when CS catheter was in the coronary sinus). Transeptal puncture utilizing fluoroscopy was used to access the left atrium. The catheter was then placed at the position of CS 3-4, where there was noted to be a fusion of the ventricular and atrial potentials. Upon ablation, within 4 seconds, the patient's tachycardia broke, and the patient returned to sinus rhythm. Many ablation points were done at and around this area. Afterwards, when ventricular pacing was performed, whereas previously there was eccentric atrial activation, after ablation, there was concentric atrial activation. Also, after ablation, when performing AV Nodal ERP, there were no evidence of accessory pathway echos, whereas prior to the ablation, we saw many accessory pathway echos. We were not able to induce tachycardia after the ablation was complete. Ablation was performed in the left atrium, at the 5 o'clock, 5:30 o'clock position on the mitral annulus (in LAO view). After ablation was complete, post-procedure measurements were obtained. Attempts to induce the arrhythmia were performed with programmed stimulation or rapid pacing. Procedure went well without any complications. Thanks. Your assistance would be greatly appreciated.