Q & A with Dr. Z: 93656 Ablation Procedure


by David Zielske, MD, CIRCC, COC, CCVTC, CCC, CCS, RCC

Question:
How would you code the following ablation procedure?

1. Pulmonary vein antral ablation was performed to isolate PV antral regions with bilateral PV isolation (PVI) confirmed on HDX mapping electrogram.

2. Additional linear ablation was performed at the left atrial (LA) roof to achieve bidirectional LA roof conduction block.

3. Additional linear ablation was performed at the left atrial (LA) lateral wall from the mitral annulus to the LPV anterior carine to achieve bidirectional LA anterior block.

93656 for the PVI then 93655 x 2 or 93655 & 93657?

Answer:
We report CPT code 93656 for PVI (pulmonary vein isolation).

After completion of a PVI, if the patient is documented to remain in atrial fibrillation after the PVI, then we additionally report add-on CPT code 93657 for additional lines. We also report CPT code 93657 after PVI if they are doing CFAE ablations (which is new for 2020).

Also new for 2020 is an increase in the MUE for CPT code 93657 to 2. We do not report a code for other empiric lines in the left atrium after PVI other than for above. Likewise, unless the patient has history of atrial flutter or has atrial flutter during the case, we do not report CPT code 93655 (for empiric ablation of the CTI).

So, again, for this case, we would only report 93656.

 

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About the Author

David Zielske, MD, CIRCC, COC, CCVTC, CCC, CCS, RCC
David Zielske is founder and President of ZHealth Publishing and primary author and editor of ZHealth publications. Dr. Z practiced as an interventional radiologist and has over twenty years experience as a coding reviewer and coding expert. He is Board Certified in Radiology and has functioned as an independent interventional radiology, vascular surgery, and cardiovascular coding consultant to a variety of physician groups and hospital providers across the country. He also served as an instructor for over 200 coding seminars.

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