93653 with 93623

[stpat]

I am hitting an edit when trying to bill 93653 (EP study and ablation for SVT) with the Isuprel drug infusion 93623. As far as I can see, 93623 is not bundled and should be able to be billed separately. Is this an error? I didn't find any corrections yet in the AMA CPT Errata listing.

 

[dpeoples]

I am hitting an edit when trying to bill 93653 (EP study and ablation for SVT) with the Isuprel drug infusion 93623. As far as I can see, 93623 is not bundled and should be able to be billed separately. Is this an error? I didn't find any corrections yet in the AMA CPT Errata listing.

stpat,
Sorry, I did not see your tread before I started mine. It really is confusing. The reason 93623 is hitting an edit is because it is an add on code and must be submitted with cpt code 93619 or 93620, which ironically, can't be billed with 93653.

Me thinks some clarification from the professional societies is needed, and quickly at that.

 

[jbhansen]

I too have found discrepancies between what add-on codes seem appropriate to bill with the new ablation codes and what the parenthetical statements following those add-on codes list as valid primary procedures. Also the CCI edits now bundle 93623 into all of the new ablation codes (93653-93657).
IMO the parenthetical statements for 93609 & 93613 should include 93656; 93621's should include 93653 & 93654; 93622's should include 93653 & 93656; and 93623's should include 93653, 93654, & 93656 (unless there is further explanation as to why CCI is now bundling this). I'm trying to seek out further clarification but have not yet found any. Frustrating isn't it?!?!

 

[Jess1125]

I too have found discrepancies between what add-on codes seem appropriate to bill with the new ablation codes and what the parenthetical statements following those add-on codes list as valid primary procedures. Also the CCI edits now bundle 93623 into all of the new ablation codes (93653-93657).
IMO the parenthetical statements for 93609 & 93613 should include 93656; 93621's should include 93653 & 93654; 93622's should include 93653 & 93656; and 93623's should include 93653, 93654, & 93656 (unless there is further explanation as to why CCI is now bundling this). I'm trying to seek out further clarification but have not yet found any. Frustrating isn't it?!?!

Found this in Medicare's NCCI manual:

29. CPT code 93623 (programmed stimulation and pacing after intravenous drug infusion) is an add-on code that may be reported per CPT Manual instructions only with CPT codes 93619 or 93620 (comprehensive electrophysiologic evaluation). CPT code 93623 should not be reported for injections of a drug with stimulation and pacing following an intracardiac catheter ablation procedure (e.g., CPT codes 93650-93657) to confirm adequacy of the ablation. Per CPT Manual instructions, CPT code 93623 is not intended to be reported with the intracardiac catheter ablation procedure codes, and confirmation of the adequacy of ablation is included in the intracardiac catheter ablation procedure.

Jessica CPC, CCC

 

[rebeccadyke84]

Thank you for finding this, Jessica. I've been having trouble with this code and wanted to find something in writing before making a decision on what not to code.
So here's my question - is it safe to assume that if a base code is bundled into another code, the base code's add-on codes follow the same rule?

 

[jbhansen]

I found the same, however it only discusses post-ablation to 'confirm the adequacy of the ablation'. I feel that it should still be a valid add-on procedure to the new ablation codes if it is used to induce the arrhythmia prior to ablation. A 59 modifier would of course be needed to clear the NCCI edit. Still waiting for clarification from the AMA and crossing my fingers it comes in the form of an Errata updating the parenthetical statements following the add-on codes.

 

[Jess1125]

I found the same, however it only discusses post-ablation to 'confirm the adequacy of the ablation'. I feel that it should still be a valid add-on procedure to the new ablation codes if it is used to induce the arrhythmia prior to ablation. A 59 modifier would of course be needed to clear the NCCI edit. Still waiting for clarification from the AMA and crossing my fingers it comes in the form of an Errata updating the parenthetical statements following the add-on codes.

Yes! I'm really hoping something comes out on this myself. And soon.

Jessica CPC, CCC