# Code 93656--ablation for a fib



## kimmyjwright (Jan 3, 2013)

This code 93656 states "a fib by ablation BY PULMONARY VEIN ISOLATION."  The code 93657 states AFTER COMPLETION OF PULMONARY VEIN ISOLATION.  My question is what if a patient has had the 93656 procedure, but comes in six months later and there is not pulmonary vein isolation performed again, just the ADDITIONAL LINEAR ALBATION (93657)---what do I bill?  93657 is an add on and can't be billed, but 93656 states BY PULM VEIN ISOLATION and that would not be done in this additional session.  What code(s) are supposed to be billed?


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## dpeoples (Jan 4, 2013)

kimmyjwright said:


> This code 93656 states "a fib by ablation BY PULMONARY VEIN ISOLATION."  The code 93657 states AFTER COMPLETION OF PULMONARY VEIN ISOLATION.  My question is what if a patient has had the 93656 procedure, but comes in six months later and there is not pulmonary vein isolation performed again, just the ADDITIONAL LINEAR ALBATION (93657)---what do I bill?  93657 is an add on and can't be billed, but 93656 states BY PULM VEIN ISOLATION and that would not be done in this additional session.  What code(s) are supposed to be billed?




This is a great question. I do not have an answer. Being that the new codes have only been in effect for a few days, there has not been time for this scenario to present itself. If you do have a return case, I would like to see the documentation.


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## Misty Dawn (Jan 6, 2013)

kimmyjwright said:


> This code 93656 states "a fib by ablation BY PULMONARY VEIN ISOLATION."  The code 93657 states AFTER COMPLETION OF PULMONARY VEIN ISOLATION.  My question is what if a patient has had the 93656 procedure, but comes in six months later and there is not pulmonary vein isolation performed again, just the ADDITIONAL LINEAR ALBATION (93657)---what do I bill?  93657 is an add on and can't be billed, but 93656 states BY PULM VEIN ISOLATION and that would not be done in this additional session.  What code(s) are supposed to be billed?



The additional codes (93657) are billed at the same time as the primary procedure and you would not be used 6mo later.  If the pt came back 6mo later for an additional linear ablation due to an arrhythmia, it would be coded with one of the primary codes.  If the pt had an afib ablation by pulm vein isolation and after testing the afib was still there requiring ablation to the RA or LA then you would code 93657 in addition to 93656.  The new codes allow for billing of additional ablation at the same time as the primary ablation.


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## kimmyjwright (Jan 7, 2013)

Misty Dawn said:


> The additional codes (93657) are billed at the same time as the primary procedure and you would not be used 6mo later.  If the pt came back 6mo later for an additional linear ablation due to an arrhythmia, it would be coded with one of the primary codes.  If the pt had an afib ablation by pulm vein isolation and after testing the afib was still there requiring ablation to the RA or LA then you would code 93657 in addition to 93656.  The new codes allow for billing of additional ablation at the same time as the primary ablation.



Yes..that scenerio is clear and not a problem...but my question is...if the patient comes back 6 months later and has an ablation WITHOUT pulmonary vein isolation...the 93656 states WITH pv isolation...so that would not be appropriate to code.  I do understand the add on codes are in the same session, but my physician asked about the code WITHOUT pv iso.  Thanks for you help


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## Misty Dawn (Jan 7, 2013)

If any of the components of a code are not done you appended a -52 modifier.  see Jim Collins/it was recent article;  I think EP digest.  To read the article on 2013
 ablation you have to create a free account with EP digest.


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## kimmyjwright (Jan 9, 2013)

I read the article and it had ALL of the information I needed...Thanks so much for your help!


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## RHENZ06ily (Jan 15, 2013)

in that case if patient has a-fib ok to code 93656 but what happen if pt. has dx of atrial flutter what code can we use? I cant use 93656 since its w/pul.vein ablation? or should i use it as 93653? Help... Thanks


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