Cardiology Coding Alert

Question: My provider performed a comprehensive electrophysiologic (EP) study where they placed wire electrodes in the heart to measure electrical activity. They punctured the thin wall between the heart chambers to access the necessary sites. My provider induced arrhythmia. They also used energy to treat the source of atrial fibrillation around the connection of the pulmonary veins to the left atrium. How should I report this?

Florida Subscriber

Answer: You should report 93656 (Comprehensive electrophysiologic evaluation including transseptal catheterizations, insertion and repositioning of multiple electrode catheters with intracardiac catheter ablation of atrial fibrillation by pulmonary vein isolation, including intracardiac electrophysiologic 3-dimensional mapping, intracardiac echocardiography including imaging supervision and interpretation, induction or attempted induction of an arrhythmia including left or right atrial pacing/ recording, right ventricular pacing/recording, and His bundle recording, when performed). This procedure is pulmonary vein isolation (PVI), which is a specific ablation technique that is performed in the left atrium to treat atrial fibrillation.

Code 93656 includes pulmonary vein isolation, comprehensive EP study (93619 and 93620), pacing and recording of the left atrium (+93621), and the transseptal approach (+93462).

Don’t miss: You also have add-on +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)). Code +93657 may only be reported in addition to code 93656 and can only be reported up to two times. You can only report 93656 once, per medical unlikely edits (MUEs).