Cardiology Coding Alert

Hint: Report 93650 for simple AV node ablation.

In Cardiology Coding Alert, Volume 25, Issue 6, you learned all about how to report electrophysiological (EP) studies in the article “Conquer Comprehensive EP Study Coding With This Expert Advice.”

Now, see what advice speakers Leigh Poland, RHIA, CCS and Srivalli Harihara, CPC, PGPAIML, had to share during the recent Virtual HEALTHCON talk “Coding Electrophysiological Study (EP)” regarding the codes you should report when your cardiologist performs an ablation procedure during the same session as an EP study.

Understand What Happens During Ablation

An ablation involves the use of special catheters to destroy the path of the errant pathway with application of radiofrequency energy or via the cryotherapeutic technique, according to Harihara. These catheters are used to destroy the route of the abnormal electrical pathway. This interrupts the electrical signal and prevents it from following the pathway ablated.

There are three distinct types of cardiac ablation: AV nodal, ventricular, and supraventricular (including atrial fibrillation ablation by the pulmonary vein isolation technique), Harihara says.

Discover Code for AV Node Ablation

An AV node ablation procedure blocks the electrical signal from passing from the atrium through the AV node to the ventricle, per Poland. A permanent pacemaker is implanted, if not already in place, following an AV node ablation to appropriately pace the ventricles.

You should report 93650 (Intracardiac catheter ablation of atrioventricular node function, atrioventricular conduction for creation of complete heart block, with or without temporary pacemaker placement) for AV node ablation. This particular code is for the catheter ablation of an AV node function, and then the AV conduction for creation of complete heart block, with or without the temporary pacemaker placement, Poland says.

Don’t miss: There may be mapping, pacing, and drug infusion documented, but they are included in that AV node ablation. The placement of a temporary pacemaker is also included in the AV note ablation.

Example: Take a look at this example from Poland: A patient with a history of implantable cardioverter defibrillator (ICD) placement has been deemed an appropriate candidate for an AV node ablation, as his biventricular pacing percentage is less than 90 percent. Prior to the study, the ICD was interrogated and found to be performing appropriately. The patient was set to VVI with a lower limit of 40 beats per minute with RV pacing only prior to the ablation procedure. Through the right femoral groin, an SRO sheath was placed. A Blazer 4mm catheter was used for pacing, ablation, and catheter mapping purposes. The 4mm Blazer catheter was placed on the His position and subsequently ablation lesions were placed. This resulted in complete heart block with subsequent RV pacing at the lower rate of 40 beats per minute. The patient was observed for approximately 30 minutes, and there was no recurrence of his native conduction. In the post procedure period, the device was once again interrogated. His battery was at the beginning of life. In terms of the atrial lead, sensing was 0.2mV with an impedance of 200 ohms. There was no underlying rhythm, and the patient was pacemaker dependent.

Solution: You should report 93650 for this simple AV node ablation.

Delve Into Supraventricular Ablation

Supraventricular (SVT) ablation includes ablation of atrial or supraventricular tachycardia, atrial flutter, atrial fibrillation, and other accessory pathways, Poland says. You should report 93653 (Comprehensive electrophysiologic evaluation with insertion and repositioning of multiple electrode catheters, induction or attempted induction of an arrhythmia with right atrial pacing and recording and catheter ablation of arrhythmogenic focus, including intracardiac electrophysiologic 3-dimensional mapping, right ventricular pacing and recording, left atrial pacing and recording from coronary sinus or left atrium, and His bundle recording, when performed; with treatment of supraventricular tachycardia by ablation of fast or slow atrioventricular pathway, accessory atrioventricular connection, cavo-tricuspid isthmus or other single atrial focus or source of atrial re-entry) for SVT.

You can report +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)) for intracardiac catheter ablation of a discrete mechanism of an arrhythmia which is distinct from the primary ablated mechanism, Poland says. You can only report +93655 up to two times, per medically unlikely edits (MUE).