# Incomplete Ablation



## leahlhaynie (May 22, 2015)

Some help would be greatly appreciated. I'm not sure what I could bill here.  The access?

"Patient was brought back to the EP lab and after informed consent was verified patient was placed under anesthesia.
After venous access was obtained a sheath was placed and a Blazer ablation catheter was positioned in the RA.
The RV lead was passive and noted to be having high thresholds at 3.0mV.
At this point patient also only 14% in Afib RVR (as opposed to >70% at the time of implant of pacemaker in Dec 2014).
We then decided to abort the procedure, since she needs dual PPM upgrade and AV nodal ablation."

Thank you!


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## BenCrocker (May 22, 2015)

The procedure code with modifier 53 for discontinued procedure looks appropriate.


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## kmuerth (May 22, 2015)

Yes. 93653-53. You always want to code to as far as they went, hence, into the atrium with the ablation catheter is justified.


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## twizzle (May 23, 2015)

leahlhaynie said:


> Some help would be greatly appreciated. I'm not sure what I could bill here.  The access?
> 
> "Patient was brought back to the EP lab and after informed consent was verified patient was placed under anesthesia.
> After venous access was obtained a sheath was placed and a Blazer ablation catheter was positioned in the RA.
> ...


You really cannot bill the ablation procedure with any modifier since no attempt at ablation was made, even though that was the intention. In any case, I presume the intention was a-fib ablation (93656 not 93653). The report doesn't make it clear since there is no pre-op diagnosis documented. I would bill 93602-26(can't remember if it needs 26 or not)-52 for atrial recording since the catheter was placed in the RA but no recordings were done. 

Modifier 53 is for discontinued due to some medical condition that would make continuing the procedure dangerous to the patient (hypotension, excessive bleeding etc) and not appropriate here. Modifier 52 indicates that components of a procedure were not performed as is the case here. No insurance would pay for the ablation when so little was done.

Anyone else got anything different, or agree?


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## BenCrocker (May 23, 2015)

Ooh good catch on that 53 error. I forgot that a chosen ending doesn't count. But it looks like it's gonna end up being a staged procedure so the next code needs that modifier. I'm away from my books so I can't remember it.


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## twizzle (May 23, 2015)

BenCrocker said:


> Ooh good catch on that 53 error. I forgot that a chosen ending doesn't count. But it looks like it's gonna end up being a staged procedure so the next code needs that modifier. I'm away from my books so I can't remember it.



No modifiers necessary since EP studies have no globals. If he does a pacer then the AV ablation later, the ablation will need a 58 providing he documents that he plans on doing the ablation later. If not, modifier 79.


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## BenCrocker (May 23, 2015)

Found this: 
According to the NCCI manual, chapter 11:
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 93610, 93612, 93619, 93620, or 93653-93656. Although CPT code 93623 may be reported for intravenous drug infusion for diagnostic programmed stimulation and pacing, it should not be reported for injections drug with stimulation and pacing following an intracardiac catheter ablation procedure (e.g., CPT codes 93650-93657) to confirm adequacy of the ablation. Confirmation of the adequacy ablation is included in the intracardiac catheter ablation procedure.

Here: http://www.hcpro.com/HIM-305516-859...ode-93623-with-electrophysiology-studies.html


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## twizzle (May 23, 2015)

BenCrocker said:


> Found this:
> According to the NCCI manual, chapter 11:
> 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 93610, 93612, 93619, 93620, or 93653-93656. Although CPT code 93623 may be reported for intravenous drug infusion for diagnostic programmed stimulation and pacing, it should not be reported for injections drug with stimulation and pacing following an intracardiac catheter ablation procedure (e.g., CPT codes 93650-93657) to confirm adequacy of the ablation. Confirmation of the adequacy ablation is included in the intracardiac catheter ablation procedure.
> 
> Here: http://www.hcpro.com/HIM-305516-859...ode-93623-with-electrophysiology-studies.html


I thought we were talking about an ablation that didn't happen. Not sure of your point with the 93623.


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## BenCrocker (May 23, 2015)

If the ablation occurred you can't use that code.


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## twizzle (May 23, 2015)

BenCrocker said:


> If the ablation occurred you can't use that code.



You're confusing me Ben. I'm not seeing any relevance to the original question.

Am I missing something?


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## BenCrocker (May 23, 2015)

Just additional information.


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## twizzle (May 23, 2015)

BenCrocker said:


> Just additional information.



Oh, OK..... good information.

Have a good long weekend Ben.


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## leahlhaynie (May 26, 2015)

That was the entirety of the procedure documentation, unfortunately. 

I can see how 93602 with a -52 would be appropriate.

Thank you so much!


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