# Ablation add on 93657 and 93656



## hofm04 (May 9, 2014)

Ablations - additional linear codes 93655 and 93657 - Is the intent of these to bill one additional regardless of the number of additional lesions (sites) that may be found after the initial ablation? I have received inconsistent information and the lack of a clear CPT definition or examples. 

Pulm vein ablation - CPT and HRS do not agree on what is included in the initial ablation for a fib. See CPT and HRS info below. 
What is included? 

93657 states left *or* right, so can 93657 be billed twice? The MUE set by Medicare on this code is 1. 
If there is an additional linear or focal mechanism, can each one be billed or just once since A fib is still remaining? Other sites : Roof line , septal, mitral valve, coronary sinus? 
Are there more sites? HRS stated or CFAE sites- What does this mean? What other terminology should we see? 

If there is a flutter after a fib is that 93955? 

*CPT description* - 
93656 Comprehensive electrophysiologic evaluation including transseptal catheterizations, insertion and repositioning of multiple electrode catheters with induction or attempted induction of an arrhythmia including left or right atrial pacing/recording when necessary, right ventricular pacing/recording when necessary and His bundle recording when necessary with intracardiac catheter ablation of atrial fibrillation by pulmonary vein isolation. 
Report 93657 when a postablation evaluation is performed after the initial PVAI and a new (not previously diagnosed) or different mechanism causing the atrial fibrillation is found and ablated.
93657 Additional linear or focal intracardiac catheter ablation of the left *or* right atrium for treatment of atrial fibrillation remaining after completion of pulmonary vein isolation (List separately in addition to code for primary proc
*Info from HRS* 
Code 93656 was valued by Medicare to include those pulmonary vein *and roof line sites* since that is a typical procedure so payment for 93656 includes ablation of those areas. The following are examples that may be helpful in determining when an add-on is appropriate, which is considered to not be a standard part of the primary ablation code. HRS was an integral part of the AMA code development and Medicare RVU assignments. 
Add-on Examples:
93655 for CTI or right/left side atrial flutter after afib ablation. Other examples include ablation of AVNRT or AVRT/ WPW discovered during the procedure. Target of an SVT after addressing a ventricular focus in the same setting.
93657 for remaining left atrium linear lesions or CFAE sites. Other examples include atrial tachycardia from the crista terminalis or any other extra-PV focus which may be initiating AF.


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## cgbar (Jul 21, 2014)

Where did you find the HRS info about the "roof line sites" and 93656. I have searched the HRS site to no avail. A link would be great.

Thanks,
Glenn


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## mariecass (Jul 30, 2015)

Did you end up getting additional information in regards to your question? I was curious what you found out. If they ablate Aflutter following PVI and it's a linear lesion for atrial flutter would it still fall under 93655? We have been following the guidelines given by CPT Assistant (July 2013).


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## morganingle (Aug 4, 2015)

what modifier is needed when charging cpt 93650?


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