Cardiology Coding Alert

Electrophysiology (EP) studies can include ablations, but these procedures might not jump out at you as you wade through lengthy EPreports. Knowing what to look for and how to code ablations will mean more money for cardiology practices. When physicians perform diagnostic EPand ablations on the same day, you should report ablation codes 93650, 93651 and 93652 separately from the EPcodes in the 93600-93623 range. (See "Look at the Whole Picture When Coding EP Studies" in the April 2003 Cardiology Coding Alert for more on EP.)

Typically, during EP, electrophysiologists induce or attempt to induce cardiac arrhythmias either by electronic stimulation or through intravenous agents. Once the physician identifies the part of the heart causing the arrhythmia, he or she places an ablation catheter adjacent to those cardiac cells and "ablates" the cells by delivering highly focused heat to destroy the nerve cells causing the arrhythmia, says Jerome Williams Jr., MD, FACC, a cardiologist with Mid Carolina Cardiology in Charlotte, N.C.

The heat is delivered during ablations by any of several methods, including direct current, radiofrequency, ultrasound and freezing, according to the North American Society of Pacing and Electrophysiology's (NASPE's) CPT Coding Guide for Electro-physiology and Pacing Procedures 2003-2004. 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. Report Multiple Ablations Once You can report ablations performed at the same time as an EPstudy because they are separate procedures, says Brian Outland, CPC, CCS, coding and reimbursement specialist with NASPE. 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 EPphysician 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).

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 College of Medicine. The documentation should specify the site. If it doesn't, the physician will [...]