Cardiology Coding Alert

Tip 3: Append Add-on Codes With Care

CPT^® also offers you the following two add-on codes that you can report along with the appropriate primary ablation code “to report ablation of sites distinct from the primary ablation site,” per the guidelines:

• +93655 (Intracardiac catheter ablation of a discrete mechanism of arrhythmia which is distinct from the primary ablated mechanism, including repeat diagnostic maneuvers, to treat a spontaneous or induced arrhythmia (List separately in addition to code for primary procedure)) Note: You can report code +93655 in conjunction with codes 93653, 93654, and 93656.
• +93657 (Additional linear or focal intracardiac catheter ablation of the left or right atrium for treatment of atrial fibrillation remaining after completion of pulmonary vein isolation (List separately in addition to code for primary procedure)) Note: You can report code +93657 in conjunction with code 93656.

Tip 4: Follow These Rules for Ablation

CPT^® also offers addition rules you should follow when reporting ablation:

Rule 1: You may separately report code +93622 (Comprehensive electrophysiologic evaluation including insertion and repositioning of multiple electrode catheters with induction or attempted induction of arrhythmia; with left ventricular pacing and recording (List separately in addition to code for primary procedure)) with codes 93653 and 93656.

Rule 2: You may separately report code +93623 (Programmed stimulation and pacing after intravenous drug infusion (List separately in addition to code for primary procedure)) with codes 93653, 93654, and 93656. However, make sure you don’t report +93623 more than once a day.

Rule 3: You should never report code 93654 in conjunction with code +93622.

Rule 4: You should never report code +93621 (Comprehensive electrophysiologic evaluation including insertion and repositioning of multiple electrode catheters with induction or attempted induction of arrhythmia; with left atrial pacing and recording from coronary sinus or left atrium (List separately in addition to code for primary procedure)) in conjunction with code 93656.

Rule 5: The code descriptors for 93653 and 93654 indicate that the cardiologist should perform right ventricular pacing and recording and His bundle recording “when necessary.” CPT^® requires that if your cardiologist could not perform one or more of those components, then he should document why he didn’t perform the service in the medical record.

Similarly, code 93656 includes left atrial pacing/recording, right ventricular pacing/recording, and His bundle recording when clinically indicated. So, if your cardiologist is not able to perform one or more of these components, he should include that information in the medical documentation.

Tip 5: Rely on This Advice for Post-Ablation EP Evaluation

If your cardiologist performs a 93653, 93654, or 93656 service, he will also perform a post-ablation EP evaluation after ablating the primary target. In these situations, your cardiologist may find additional mechanisms of tachycardia.

“Essentially a discrete mechanism of arrhythmia (+93655) is a different type or origin/pathway of arrhythmia from what the patient has had their original ablation for,” says Robin Peterson, CPC, CPMA, Manager of Professional Coding Services, Pinnacle Integrated Coding Solutions, LLC. “A physician may originally detect one arrhythmia during the initial EP study, like atrioventricular nodal reentrant tachycardia (AVNRT), but on restudy after ablation, find another arrhythmia, like orthodromic reentry tachycardia that requires additional ablation.”

If the additional mechanism or arrhythmia is atrial (but not AFib), you should report this with add-on code +93655, Peterson says. If the discrete mechanism of arrhythmia is ventricular tachycardia or ventricular ectopy, you should report, add-on code +93655.

“The only time add-on code +93657 is billed is when after the complete pulmonary vein isolation is performed atrial fibrillation remains and requires additional ablation,” Peterson adds.

Check out these two examples from Peterson:

Example 1: The physician performs an ablation of ventricular tachycardia, and during post-ablation testing, he sees AVNRT. The AVNRT would be considered a different, distinct mechanism of arrhythmia and after further pacing maneuvers to define the pathway and origin of this AVNRT, the physician performs ablation. The physician performs post ablation attempts at re-induction and then terminates the procedure. You should report 93654 (Comprehensive electrophysiologic evaluation including insertion and repositioning of multiple electrode catheters with induction or attempted induction of an arrhythmia with right atrial pacing and recording, right ventricular pacing and recording (when necessary), and His bundle recording (when necessary) with intracardiac catheter ablation of arrhythmogenic focus; with treatment of ventricular tachycardia or focus of ventricular ectopy including intracardiac electrophysiologic 3D mapping, when performed, and left ventricular pacing and recording, when performed) with the additional ablation code +93655 (Intracardiac catheter ablation of a discrete mechanism of arrhythmia which is distinct from the primary ablated mechanism, including repeat diagnostic maneuvers, to treat a spontaneous or induced arrhythmia (List separately in addition to code for primary procedure).

Example 2: During ablation for complete pulmonary vein isolation on a patient with atrial fibrillation, the physician sees atrial flutter during post-ablation testing. The atrial flutter is considered a discrete mechanism of arrhythmia distinct from the atrial fibrillation. After further pacing maneuvers to define the pathway of the atrial flutter, the physician performs an ablation. The physician performs post ablation attempts at re-induction and then terminates the procedure. In this scenario, you should report 93656 (Comprehensive electrophysiologic evaluation including transseptal catheterizations, insertion and repositioning of multiple electrode catheters with induction or attempted induction of an arrhythmia including left or right atrial pacing/recording when necessary, right ventricular pacing/recording when necessary, and His bundle recording when necessary with intracardiac catheter ablation of atrial fibrillation by pulmonary vein isolation) with the additional ablation code +93655 (Intracardiac catheter ablation of a discrete mechanism of arrhythmia which is distinct from the primary ablated mechanism, including repeat diagnostic maneuvers, to treat a spontaneous or induced arrhythmia (List separately in addition to code for primary procedure).