EP Coding and Billing

In the January issue of EP Lab Digest®, Jim Collins, CPC, CCC from CardiologyCoder.Com and CardiologyBiller.Com, presents information on their EP & CRM superbill. One of the first things he does for new billing clients is implements effective charge capture tools such as this one. Here he provides critical information that must be understood by each physician using this form.

Jim Collins is a frequent contributor to EP Lab Digest®. Don’t miss his upcoming article entitled “Assessing Lifetime Value (LTV) of Patients: Lessons from a Dairy Farmer” in our February 2014 issue. In this article he describes some of the unexpected similarities between operating a successful dairy farm and a cardiology program; ultimately, both go to great lengths to enhance lifetime value. Specifically, he takes into account the management of the heart failure patient versus the warfarin patient in a successful cardiology program.

For more articles on coding/billing tips and advice, please visit:

• Top Ten List: Things Electrophysiologists and Cardiologists Can Do to Increase Profitability

• Changes Coming for 2013 CPT Codes

• Top Ten Regulatory Landmines in EP

• Three Coding Updates for 2013

• The RAC Racket


BIOTRONIK Case Studies and News

BIOTRONIK announced today that the first patients have been enrolled in an expansion of their ongoing ProMRI® trial. The ProMRI® clinical study aims to determine whether device patients can safely undergo full-body MRI scans. The study will recruit and evaluate 245 patients at 35 U.S. investigational centers. The ProMRI® full body scan expansion is designed to confirm the safety and efficacy of BIOTRONIK’s existing dual- and single-chamber Entovis pacemaker systems and Setrox leads during a MRI scan. The BIOTRONIK-sponsored trial (NCT01761162) has been in U.S. subject recruitment since March 2013. For more information, please visit http://www.biotronik.com.

In related BIOTRONIK news, authors Salam Sbaity, MD and Kandis Ciesielski, BSN, RN describe in the January issue of EP Lab Digest® how atrial lead diagnostics and intracardiac electrograms (IEGMs), coupled with the ability of the implanted device to monitor 24/7, can be very helpful in making the diagnosis of subclinical atrial fibrillation in patients with implanted devices. They present a case of a patient who underwent implantation of a single-chamber BIOTRONIK DX ICD. This single-lead ICD includes provisions for atrial sensing, atrial diagnostics, and SVT discrimination; these are accomplished by using a Linox S DX ICD lead. They write that the addition of an atrial IEGM provided confirmation that the rhythm discriminator both appropriately withheld and treated the different episodes in this patient, and that clinical evidence suggests that the use of atrial IEGMs dramatically improves a clinician’s accuracy of rhythm classification.

Check out our issue next month for another interesting case. Douglas R. Moore, DO, FACC discusses ICD implantation in a 34-year-old patient with sarcoidosis and a diagnosis of intermittent AV block who is at risk for sudden cardiac death. Due to this patient’s young age and diagnosis, the BIOTRONIK Ilesto DX and a Linoxsmart S DX lead were chosen. The Ilesto ICD offered defibrillation therapy for the patient’s risk of sudden cardiac death and provided AV sequential pacing for his intermittent complete heart block. The DX system and Linoxsmart S DX lead (a single-coil ventricular lead with an atrial dipole) limited the amount of hardware. In addition, this ICD is one of the smallest available. This article will appear in EP Lab Digest®’s upcoming February 2014 issue. Continue reading

Freezing Temperatures

Screen Shot 2014-01-23 at 2.03.14 PMThe new buzzword these days seems to be “polar vortex”, an arctic blast that is currently sending freezing temperatures to much of the U.S.

In the January issue of EP Lab Digest®, Andrew Wickliffe, MD and Dan Dan, MD from Piedmont Heart Institute in Atlanta, Georgia, present an article on another type of deep freeze: cryoablation. They describe a case of a 64-year-old male who was diagnosed with paroxysmal atrial fibrillation about 5 years ago. The patient initially underwent pulmonary vein isolation using irrigated radiofrequency energy, which was was acutely successful. However, the patient later required a repeat ablation, and underwent a balloon cryoablation approximately 1 year ago. Since then, he has continued to have no evidence of symptoms of recurrent atrial fibrillation, which has been confirmed by an ILR monitor.

The authors conclude that balloon cryoablation for paroxysmal atrial fibrillation is a safe and effective therapy. Their institution has noted significant decreases in procedure time, fluoroscopy time, and left atrial dwell time when compared to traditional radiofrequency pulmonary vein isolation procedures.

Upcoming AF Symposium

The upcoming 19th Annual Boston AF Symposium is scheduled to take place January 9-11, 2014 at the Orlando World Center Marriott in Florida. This symposium, which was initiated in 1995, has become a major scientific forum for health care professionals to learn about the most recent advances in the field of atrial fibrillation. We look forward to this year’s scientific program! Just some of the highlights include sessions on Alternative Therapies for Atrial Fibrillation (presented by Eric Prystowsky, MD), The Ablation Lesion or the Atrial Disease: Lessons Learned from DECAAF (presented by Nassir Marrouche, MD), and Renal Denervation for AF – Physiology, Mechanisms of Action and Rationale in AF (presented by Vivek Reddy, MD). The meeting will also include satellite case presentations on topics such as Individualized Cryoballoon Ablation for PAF (presented by Boris Schmidt, MD and KR Julian Chun, MD) and Thermal Balloon Ablation for Paroxysmal AF (presented by David Haines, MD). Other hot topics from this year’s meeting include Left Atrial Appendage Closure Devices for Stroke Prevention and Current Clinical Trials and Registries in Atrial Fibrillation.

For additional information on various featured topics from the meeting, please check out articles in the January issue of EP Lab Digest®, including Dr. Khan Pohlel and Dr. Kent R. Nilsson’s case on LAA exclusion using the LARIAT suture delivery device (SentreHeart, Inc.) or the clinical trial overview of the CardioFocus HeartLight® Ablation System from Dr. Frank A. Cuoco and colleagues.

In addition, while you’re attending the meeting, don’t forget to stop by EP Lab Digest@’s booth (#617)! See you there!

Benefits of the S-ICD

In a recent issue, author Angela E. Raymer, RT(R), MBA and colleagues discuss implantation of Boston Scientific’s S-ICD® System at the Parkview Heart Institute, part of Parkview Regional Medical Center in northeast Indiana. The subcutaneous ICD (S-ICD) is an implantable defibrillation system that avoids vascular access or the use of fluoroscopy. The Heart Institute’s approval to implant status is the result of a long-term research relationship between Parkview and the clinical trial efforts (IDE study, Cameron Health) that preceded the device approval. Efforts are now being made to enroll S-ICD recipients in a post-market study with Boston Scientific and Cameron Health. The authors write that the S-ICD® System offers new options for patients who may otherwise endure complicated implantation procedures due to compromised vasculature. They also note that the S-ICD procedure has another added benefit: the reduced rate of complications, when compared to intravascular implantation, translates into fewer readmissions and a shorter length of stay.

In an editorial last month, EP Lab Digest® Editor-In-Chief Dr. Bradley Knight wrote that there are several advantages to the S-ICD, including that unlike a transvenous ICD, it can sense from three different vectors. However, the S-ICD is also vulnerable to T-wave oversensing (TWO). Dr. Knight concluded that more work is needed to improve the sensing algorithm in the S-ICD to avoid TWO, so that more patients can take advantage of this technology.

For additional information on the S-ICD, please check out Dr. Steven Kutalek’s overview on the its application to clinical practice from May 2013.