Cardiology Coding Alert

Question:  How should I code this service?

Two 4fr sheaths placed to LFV. 7FR to RFA and 6FR to RFV. Catheters placed to HRA, HIS, RV, and CS. SNRT (sinus node recovery time) normal, infranodal conduction normal, and no AH jump. Left posterior-lateral accessory pathway found and ORT induced with single PAC 600/300mc with CL 359mc. 4mm ablation catheter with 3D electro anatomical mapping confirms posterior lateral accessory pathway. RFA delivered and suppressed pathway and repeat delivery 5mm lateral completely suppressed and disappearance of pathway, successful ORT ablation. Successful post lateral concealed pathway ablation.

Codify Member

Answer: Final coding depends on the complete documentation, but based on the excerpt provided you should report:

• 93653, 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, His recording with intracardiac catheter ablation of arrhythmogenic focus; 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
• +93613, Intracardiac electrophysiologic 3-dimensional mapping (List separately in addition to code for primary procedure).

The physician mentions the use of multiple electrode catheters and induction of ORT, which stands for orthodromic reentrant tachycardia. ORT is a type of supraventricular tachycardia (SVT). The documentation also includes the use of ablation to treat the ORT. These services fall under 93653.

The excerpt also includes 3D mapping. This service (+93613) is reportable in addition to 93653.