Cardiology Coding Alert

Then be sure you understand the difference between +93655 and +93657.

In Cardiology Coding Alert, vol. 19, no. 4, "Pick Paroxysmal Atrial Fibrillation Case Codes" featured a question about coding pulmonary vein isolation (PVI) and right atrial isthmus ablation for a patient with paroxysmal atrial fibrillation.

The answer given was to 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) for the ablation.

After reading the article, a reader asked whether an add-on code would be appropriate for the right atrial isthmus ablation. The answer is, it depends.

Ask Whether the Ablations Treat Different Arrhythmia Mechanisms

To determine whether you should report an add-on code in addition to PVI code 93656, check the documentation to see whether the right atrial isthmus ablation and PVI are related to the same arrhythmia mechanism. If so, you should not report an add-on code, explains Christina Neighbors, MA, CPC, CCC, coding quality auditor for Conifer Health Solutions in the Coding Quality & Education Department.

However, if the right atrial isthmus ablation is for a different arrhythmia, meaning a discrete mechanism distinct from the primary ablated arrhythmia, you may report an add-on code, Neighbors says.

+93655: For ablation of an additional tachycardia mechanism such as atrial flutter (but not atrial fibrillation) after PVI, you should consider +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]).

+93657: According to the July 2013 CPT^® Assistant, for ablation of an additional atrial fibrillation focus from a non-PVI mechanism remaining after successful PVI, consider +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: To avoid confusion, we'll remove "right atrial isthmus ablation" from the online posting on Codify of "Pick Paroxysmal Atrial Fibrillation Case Codes."