Society Successfully Advocates To Maintain Reimbursement for Comprehensive EP Evaluation Services

The Heart Rhythm Society, in conjunction with the American College of Cardiology (ACC), seems to be headed for a significant victory over the American Medical Association (AMA) CPT/RUC Joint Workgroup in maintaining separate reimbursement for comprehensive EP study codes 93620 and 93621.

Several months ago, the AMA CPT Editorial Panel and the RVS Update Committee (RUC) formed a workgroup to review code pairs that are reported together very frequently to determine whether the services are potentially misvalued. Comprehensive electrophysiologic (EP) evaluation (93620) and add-on code left atrial pacing and recording (+93621) were identified as part of the review process. The Workgroup proposed to combine 93620 and 93621 into a single service to address any potential duplication in work values.

In an appeal letter (PDF,60K), the Society and ACC expressed strong opposition to bundling 93620 and 93621 after reviewing the valuation and history of these services. Prior to 2002, CPT code 93621 was a stand-alone code but was changed to an add-on code because of confusion in the descriptor language when reported together with 93620. Revisions were made at that point, along with appropriate service time and payment differentials to avoid rank order anomalies when taking into account the additional work for left atrial pacing and recording, and to avoid overlap in work for arrhythmia induction or attempted arrhythmia induction.

As a result of the Society’s advocacy efforts, the Workgroup acknowledged that it is unnecessary to bundle these particular services, as there is no duplication of work. “The Workgroup’s decision is a victory for the EP community,” said Society President N.A. Mark Estes, MD, FHRS. The bundle, had it been adopted, would have resulted in substantial payment cuts for comprehensive evaluation services.