2025 CPT code 93631
Effective Date: N/A Medicine - Cardiovascular Procedures Feed
Intraoperative epicardial and endocardial pacing and mapping to localize the site of tachycardia or zone of slow conduction for surgical correction.
Modifiers 26 and TC are applicable.
Medical necessity is established by pre-operative diagnosis of a cardiac arrhythmia requiring surgical intervention during open-heart surgery. Documentation should support the decision for surgical intervention.
The physician is responsible for performing the procedure, interpreting the results, and guiding the surgical correction.
In simple words: This procedure involves mapping the heart's electrical activity during open-heart surgery to find the source of an abnormal heart rhythm. The doctor places electrodes on both the inside and outside of the heart to record its electrical signals and identify the area causing the fast or irregular heartbeat.
Intraoperative epicardial and endocardial pacing and mapping are techniques of recording cardiac electrical activity directly from the heart. The goal of this procedure is to localize the abnormal heartbeat generating foci of the heart for surgical correction. Before or during the surgery, the provider inserts a venous sheath for femoral vein access. He then inserts an electrode catheter and threads it through the venous sheath under fluoroscopic guidance and advances the electrode into the heart to prepare for endocardial pacing. For epicardial pacing, he places electrodes on the outside of the heart. He then performs epicardial and endocardial pacing and recording. The provider uses the catheter to transfer electrical signals to the heart tissue to initiate the abnormal heart rhythm. The provider then maps the spread of electrical signals during the abnormal heart rhythm and tries to localize the source of the abnormal heart rhythm.
Example 1: A patient undergoing open-heart surgery for mitral valve repair also experiences atrial fibrillation. Code 93631 is used to map the electrical activity and guide surgical ablation of the arrhythmogenic focus., A patient with Wolff-Parkinson-White syndrome undergoes open-heart surgery. Code 93631 is used to map the accessory pathway and guide surgical ablation., A patient with ventricular tachycardia undergoes open-heart surgery. Code 93631 is used to map the ventricular tachycardia focus and guide surgical ablation or other corrective procedures.
Documentation should include operative notes detailing the placement of electrodes, the pacing and mapping process, the identified source of the abnormal heart rhythm, and any surgical correction performed. Pre-operative diagnostic studies related to the arrhythmia should also be documented.