Wiki Codes 93621 and 93623 billed with 93653

[jrandhan]

We are having a terrible time with the new ablation codes. The CPT book says you can only bill codes 93623 and 93621 with a complete EP study, code 93620. That code is bundled into 93653. We are unable to get codes 93621 and 93623 past our claims manager edits. I don't see anywhere that it says we can't bill those two codes with 93653 Does anyone have any insight into this problem?

Jeannie Randhan, CCC

 

[rpeterson]

When you look up the CPT code 93621 the paranthetical in the CPT book says to use it in conjunction with code 93620. 93623 paranthetical says to use it in conjunction with 93619 and 93620.
CMS has said that they will change their edits if CPT sends out an errata on the parantheticals for the two codes. If you look up the CCI edits from CMS, code 93653 is set to bundle 93623 but does not bundle 93621. Hopefully they take off the edit for the 93623 as well. Your software is following the CPT parantheticals but I've advised my coders to bill for the 93621 as the CMS CCI edits do not have it bundled into 93653 or 93654. We are waiting to see what CPT will do about the 93623.

Refer to zhealthpublishing article for reporting ablations in 2013:

On November 30th, the 2013 National Correct Coding Initiative Policy Manual for Medicare Services was released. The manual has the following new instruction which contradicts the instruction in the CPT Code Book:

“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.”

While CMS references the CPT Code Book for their policy on code 93623, it appears to be contradictory to the AMA's recommendation. However, since we follow CMS guidelines for coding, we do not recommend reporting 93623 with any of the cardiac ablation codes at this time.

Robin Peterson, CPC

 

[kimmyjwright]

I had been billing the 93621 and most payers paying...now one of the largest payers has starting recouping money, stating that it MUST be billed with the 93620...i do understand it an add on code, but just not sure...I do see "add on " status, but then I receive multitudes of information stating it can be billed with 93653...can others please advise? Thanks!