Electrophysiology Year in Review: 2007 The Three R's of Electrophysiology

Todd J. Cohen, MD, Editor-in-Chief, EP Lab Digest, Director, Electrophysiology, Cardiology Division, Winthrop-University Hospital, Mineola, New York
Todd J. Cohen, MD, Editor-in-Chief, EP Lab Digest, Director, Electrophysiology, Cardiology Division, Winthrop-University Hospital, Mineola, New York
Robotics At the Heart Rhythm Society annual scientific sessions in May 2007, the word for the day was robotics. There was a huge amount of buzz regarding the approval of Hansen Medical s Sensei Robotic Catheter System as well as the intrigue of the Stereotaxis Niobe ® Magnetic Navigation System. Another important phrase of the day was remote navigation. The Hansen Medical system is a robotic system that employs a 14 French steerable sheath in which the ablation catheter is passive. A large control station with a new concept in catheter manipulation was introduced at the meeting, where the entire system was on display. In addition, Stereotaxis, which uses magnetic navigation and soft flexible catheters guided by a magnetic field, was also on display. Recalls Recalls, which have plagued the past two years, saw a comeback in 2007 with Medtronic s Sprint Fidelis ® defibrillator lead recall. The manufacturer reported that in 30 months, there was a 2.3% malfunction rate with this lead and five deaths reported in approximately 265,000 implants.1 Because of this, a Class I recall was issued in October via the United States Food and Drug Administration.2 Guidelines were also issued via an independent panel and operators had the huge task of making heads or tails of how to address these problems. Specifically, patients who had a significant dependency on these leads were addressed either via device reprogramming and close monitoring verses the addition of a new defibrillator lead. Reimbursement Changes in reimbursement to the hospital regarding the technical side of these procedures began in October 2007, and additional changes to physician billing and reimbursement will begin as of January 1, 2008. Additional technical ICD-9 codes were required as of October 2007 in order to achieve appropriate reimbursement. In addition, the Heart Rhythm Society reported that as of January 1, 2008, for many procedures that are performed in tandem with basic electrophysiology procedures, the electrophysiologist will receive a 50% reduction in reimbursement (a loss of the 51 modifier exemption). It is important for electrophysiology operators as well as their administrators and/or institutions to be aware of these changes in order to stay ahead of the curve. Remember the Three R s In summary, as in school, it is important to be aware of the three R s. In electrophysiology, those three R s for 2007 were Robotics, Recalls, and Reimbursement. Keep posted to EP Lab Digest for more on these subjects in the near future.