Cardiology Coding Alert

Learn what you should report for a transseptal approach Electrophysiology (EP) studies can include ablations, but these procedures might not jump out at you as you wade through lengthy EP reports. Knowing what to look for and how to code ablations will ethically add to your cardiology practice's revenue.
First, Learn What Ablations Are Frequently, during an EP study, electrophysiologists induce or attempt to induce cardiac arrhythmias by electronic stimulation, sometimes with the assistance of intravenous agents. Once the physician identifies the part of the heart causing the arrhythmia, he occasionally places an ablation catheter adjacent to those cardiac cells and "ablates" the cells by delivering highly focused heat, cold or radiofrequency energy to destroy the nerve cells causing the arrhythmia, says Jerome Williams Jr., MD, FACC, a cardiologist with Mid Carolina Cardiology in Charlotte, N.C.

Physicians also perform ablations to interrupt extra electrical "pathways" in the heart, such as atrioventricular (AV) node re-entry or accessory pathways, which occur in Wolff-Parkinson-White syndrome, Williams says. Coding ablations can be tricky, but these five expert tips will have your claims cleared up in no time. Tip 1: Bill Ablation Codes Separately From EP Studies The first thing you should know is that you should report ablation codes 93650-93652 separately from EP study codes in the 93600-93623 range when physicians perform ablations on the same day as an EP study. Why: In this situation, ablations are separate procedures. Moreover, when you report catheter ablation, "code 93650, 93651, and/or 93652 should be reported once to describe ablation of cardiac arrhythmias, regardless of the number of arrhythmias ablated," CPT states. Specifically, report 93650 (Intracardiac catheter ablation of atrioventricular node function, atrioventricular conduction for creation of complete heart block, with or without temporary pacemaker placement) when the EP physician performs an AV node ablation to correct conduction abnormalities in the AV pathway. You should bill 93651 (Intracardiac catheter ablation of arrhythmogenic focus; for treatment of supraventricular tachycardia by ablation of fast or slow atrioventricular pathways, accessory atrioventricular connections or other atrial foci, singly or in combination) for supraventricular tachycardia (SVT) due to dual AV nodal re-entry pathways, accessory atrioventricular connections or other atrial foci. "Supraventricular" indicates arrhythmias arising above the ventricles. When the physician performs catheter ablation for ventricular tachycardia, report 93652 (... for treatment of ventricular tachycardia). Tip 2: Zone in on Target Site Second, make sure the documentation clearly identifies the ablation target site. Why: To choose the correct code, you'll need to know the exact ablation target site, says Terri Davis, CPC, coding supervisor for the internal medicine department at the University of Oklahoma's College of Medicine. The documentation should specify the site. If it doesn't, the physician will need to provide this [...]