There is a lot of low-hanging fruit in most cardiology and electrophysiology practices. Following are the top ten areas in which you can increase the profitability of your practice.

#10: Be Aware of Your Post-Op Billing Opportunities
Reimbursement for pacemaker and defibrillator surgeries includes routine surgical recovery services provided in the 90-day post-operative period. This is most commonly limited to discharge following the procedure and an incision site check shortly after discharge.

However, Medicare policy specifies that “Treatment for the underlying condition or an added course of treatment which is not part of normal recovery from surgery” and “Visits unrelated to the diagnosis for which the surgical procedure is performed” are separately reimbursable. Medicare requires that we attach the 24 modifier to these evaluation and management services to confirm that they are not routine post-operative care.

Fifteen years of donning a lead apron has taught me many lessons. A very wise friend once told me success in any endeavor really involves mastering the obvious. This is clearly the case in practicing medicine and more specifically, achieving favorable results in the electrophysiology lab.

Our lab is humbly equipped. There is a late model mono-plane fluoroscopy unit, a singular three-dimensional mapping system, an intracardiac ultrasound (ICE) device and an irrigated ablation system. A robot, MRI and multiple 3D mapping systems are notably absent. Enough equipment is available to achieve success, but not so much to allow dust to settle.

What is the size of your EP lab facility and number of staff members? What is the mix of credentials at your lab?
We have one dedicated EP lab with three staff members, including two RNs and one cardiovascular technologist. We are all EP-certified (RCES) by Cardiovascular Credentialing International.

When was the EP lab started at your institution?
The EP lab opened in the fall of 2007, one year after Florida Hospital Zephyrhills started its open-heart program. We have two electrophysiologists on staff: Dr. Nadim Khan and Dr. Dilip Mathew.

What types of procedures are performed at your facility?
We perform all diagnostic and interventional electrophysiology procedures, which include atrial fibrillation ablations and 3D mapping cases. Device implants include loop recorders, pacemakers, ICDs and biventricular devices. On occasion we perform TEEs, cardioversions and NIPS. We have begun to do venoplasty due to the increase in upgrading devices.

Dear Readers,
Anyone involved in pacemaker and defibrillator implantation understands that there is a significant risk of infection after device implantation and that the management of these infections can be particularly challenging. Two important papers were published early this year related to implantable device infections and their management. The first was a Scientific Statement from the American Heart Association entitled “Update on Cardiovascular Implantable Electronic Device Infections and Their Management.”1 The purpose of the update was to educate clinicians about device infections, provide explicit recommendations, and highlight opportunities for research. The paper provides a summary table of recommendations. Below is a paraphrased and abbreviated list of those recommendations.

Recommendations for antibiotic prophylaxis at the time of device implantation.

Dr. Sauer is an Assistant Professor of Medicine and the Director of Electrophysiology Laboratories at the University of Colorado Hospital (UCH) in Aurora, Colorado.

Tell us about your medical background and how you came to work in the field of electrophysiology. What interested you about this field?

In this interview we speak with Matthew M. Burg, PhD, Associate Clinical Professor of Medicine at Yale University School of Medicine. Dr. Burg is the Principal Investigator of the Reducing Vulnerability to ICD Shock Treated Ventricular Arrhythmias (RISTA) Study, a randomized, single-blind trial currently underway.

What prompted the RISTA study? What is the purpose of the RISTA study?

Hearts with Hope (Corazones Con Esperanza) Foundation was incorporated in 2005. However, its roots go back many years before that — it was the result of many years of volunteer efforts in Latin America.

The AFib Support Team, brought together by sanofi-aventis U.S., is a new national public awareness campaign that provides information for atrial fibrillation patients to help them manage their condition. The AFib Support Team is made up of an electrophysiologist, a cardiovascular nurse, a senior fitness expert and a lifestyle gerontologist. We talk to them about the initiative here.

Bradley P. Knight, MD, FACC, FHRS

What prompted the creation of the AFib Support Team initiative?

Henry Ford Macomb Hospital recently switched to the PerfectServe system to reduce communication breakdowns among its clinicians. PerfectServe is a clinical communications system linking hospitals and practices that automatically routes calls and messages to physicians in the manner in which they wish to be reached. By transitioning to PerfectServe, the hospital has facilitated more peer-to-peer communications among physicians, improved the coordination of care and reduced risks. In this interview we speak with Dr. Steven Harrington, a leading cardiac robotic surgeon at Henry Ford Macomb Hospital, about his use of the PerfectServe system and how it helped with effective care coordination. Henry Ford Macomb Hospital is located in Clinton Township, Michigan.

Describe your position at Henry Ford Macomb Hospital. What is a typical day like for you?

This report demonstrates the production and use of 3-D reconstruction of a coronary sinus from a single-injection rotational angiogram. The detailed virtual model enabled easy magnetic navigation of a wire for device placement in cardiac resynchronization therapy.