It has been another busy month for the email discussion group! Many of you have sent in new questions and responses — please take a look and see what you can help with. If you would like to respond to these questions, please email us at eplabdigest@hotmail.com or go to www.eplabdigest.com and click on the email discussion group link. Our website is constantly being updated, so please check back often!

New Questions:

Working Abroad
I am interested in possibly working in an EP lab in either London or Paris for six months to a year. Does anyone know how I can go about doing this? Any information will be greatly appreciated.
— anonymous
Readers, to reply to this question, please type “Working Abroad” in your subject line.

Multiple Cardioversions, Same Session
How would you bill for multiple external cardioversions, same patient, same physician, same session. Can you only assign CPT code 92960 no matter how many times it takes to convert the patient?
— Lyn Giusti, CPC-CHA
Readers, to reply to this question, please type “Multiple Cardioversions” in your subject line.

Finding a Buyer
Our EP lab is planning to install a new 3D mapping system next week and would like to know if there are any emerging EP labs that might be interested in a gently used, fully functional Medtronic LocaLisa. I have no idea where to post something like this or how to make contact with labs who might be interested. I hate to see it collecting dust in a closet when a new lab could benefit from the equipment and the low cost of buying it used. Any ideas would be appreciated.
— Sharon Purkis, MBA, VP Cardiovascular Services
Readers, to reply to this question, please type “Finding a Buyer” in your subject line.


Under Discussion:

Free-Standing Lab
I need to know if anyone is getting reimbursed for EP studies done in a free-standing cath lab. We are going to be opening one in a couple of months and we need some input on the feasibility of using this for our EP studies. We are in the state of Florida, and as of right now, no one is doing this as far as we know. Please help.
— P. Vowell, Coding/Billing Specialist
Readers, to reply to this question, please type “Free-Standing Lab” in your subject line.

Pay for CVTs
Is there a database or has anyone done a study for the pay ranges for CVTs working in the EP lab? I am not able to find out the pay scales for the Midwest and what responsibilities/job descriptions the CVTs are accountable for. Many labs in the Michigan area have RNs, RVCTs, RCIS's, and CVTs working the labs. Any help or direction in this matter would be appreciated.
— Patricia from St. John Health System
Readers, to reply to this question, please type “Pay for CVTs” in your subject line.

Credentialing and Education for EPs
Do you think there should be a credentialing exam for Electrophysiology technologists, analogous to the RCIS examination? Also, in your opinion, is there a need for formal education programs for electrophysiology?
— Letitia P. Esbenshade-Smith, Staff Educator, Cardiac Electrophysiology
Readers, to reply to this question, please type “Exam/Education” in your subject line.

I feel that many of us have the experience along with RCIS, which should suffice. The hospital should provide annual competencies to make certain that you are keeping up with the current therapies and trends.
— Patricia from St. John Health System, Warren, Michigan

Mixed Cath labs with RNs and CVTs
I was asked by our Union for Nursing to research the pros and cons of having a mixed cath and EP lab with RNs and CVTs. Does anyone have any information so I don't have to reinvent everything? The lab now has one full-time RN who was a CVT prior to getting his nursing degree. We are going to expand from two suites to six suites over the next two years.
— anonymous

What are you specifically looking for to prevent "reinventing everything”? I work in an EP/Implant lab; that is to say; one designated lab for EP and one designated implant (pacer, ICD) lab. We have 7 staff members: three RNs and four RCIS's. We do more implants than EP procedures because it is Southwest Florida. Both professional credentialings are cross-trained to all procedural positions. The positions are scrubbing, circulating, and conscious sedation. Yearly competencies are performed every year to maintain and document levels of proficiency. The RCIS’s are trained to administer conscious sedation. The RNs are trained to scrub all the procedures. The one caveat that the EP lab/Implant lab must obey is that there is a registered nurse in every case. The medication administration policy and procedures stipulate that medications are given under the supervision of a registered nurse in all procedures. The RNs are comfortable with this policy. No Diprivan, Bretylol, or Ketamine are administered by RNs and RCIS’s. Those medications are only given by a properly privileged cardiologist and/or anesthesiologist and CRNA.
Since both credentials can basically do everything, the "attitude" can be that both RCIS’s and RNs are equal in all aspects. That is perhaps the major friction area in having cross-trained individuals. We are the only EP/Cath lab that practices this way. Most of the Florida cath labs only permit the RNs to administer medications, so RNs are limited to circulating and patient care. The RCIS’s are then limited to scrubbing and recording cases. I believe the latter is practiced, because in Florida only the RNs are licensed. This is legislative activity to license RCIS’s, but so far I am aware that only South Carolina has licensure for RCIS.
— Dana St. John, RN

We have four dedicated labs, and have a mix of RNs and techs. The RNs give sedation, and the techs do everything else. The techs' backgrounds are varied — nursing, paramedics, radiology techs, CVT school grads. It works because we have a lot of education and a very participative lab. In PA, there is no law stating that only radiology techs can move x-ray equipment (in fact, our controls are table-mounted and the physicians usually do it). But that is something you need to keep in mind as you decide on a staffing mix — state and hospital regulations and policies. Also, what do your techs do in a room? Are they bystanders or actively running the stim box, running the recording system, etc.? You have to know what your staffing needs are and can be, and then find the people to fill your slots.
— anonymous

For EP Techs
I just visited and am new to the field, so I wondered if there are any good user groups for an EP lab tech? I am in Boston, but via the web I could access groups anywhere.
— name withheld
Readers, to reply to this question, please type “EP Techs” in your subject line.

These sites have course offerings for EP-related subject matter. Some are free and some are not:
Cardiovascular Credentialing International (www.cci-online.org)
Society for Invasive Cardiovascular Professionals (www.SICP.com)
Heart Rhythm Society (www.hrsonline.org)
American College of Cardiology (www.acc.org)
Boston Scientific (www.bostonscientific.com)
St Jude Medical (www.sjm.com)
Guidant website (www.guidant.com)
Medtronic (www.medtronic.com)
Biosense Webster, Inc. (www.biosensewebster.com)
Medscape (www.medscape.com)
— Dana St. John, RN

Mapping System
If the facility has a budget to buy only one mapping system, either CARTO or EnSite, what is the one system to buy?
— anonymous
Readers, to reply to this question, please type “Mapping System” in your subject line.

Staff Placing Catheters for Diagnostic EP Studies
I was wanting to know if EP techs anywhere are placing diagnostic EP catheters after being trained by a EP physician?
— name withheld

I have been trained by our EP doctor to place catheters in the CS, HRA, RVA, RVOT, etc. for the purpose of diagnostic testing during EP studies. The hospital in which I work now feels that this is not the standard of care; therefore, they will not allow this anymore. The doctor that trained me states that this is being done across the country. What are the standards of care regarding this matter? What policies are in effect at other facilities across the country?
— V. Maestas, ARRT RT (R)(T)(CV)

Establishing an EP Lab (Overseas)
Our hospital is a tertiary cardiac care center located in the southern part of Delhi, India. We are looking for established EP centers to help us in starting an EP lab and arrhythmia services at our center. Can you help?
— V. Sharma, MD
Readers, to reply to this question, please type “Delhi EP Lab” in your subject line.

I would be very eager to help you establish an arrhythmia program at your institute. Please e-mail me directly so that we may assist you in your venture.
— name withheld