Cardiology Coding Alert

Take action to secure the dollars you’ve earned since January.

Good news: Correct Coding Initiative (CCI) version 19.2 offers up some much needed edit deletions for electrophysiology (EP) codes, effective July 1, 2013.

Better news: These edit deletions are retroactive to Jan. 1, 2013. So if you received any denials based on these edits, you can now contact your payer to receive payment for the denied codes.

Put Programmed Stim Code Back on Your List

A sizeable collection of deletions allows you to report programmed stimulation and pacing code +93623 in addition to EP study and/or ablation codes 93653-+93657 (defined below). Coders have known this change needed to happen and have been waiting for this update, notes Christina Neighbors, MA, CPC, CCC, ACS-CA, a cardiology coding expert in Tacoma, Wash.

• +93623, Programmed stimulation and pacing after intravenous drug infusion (List separately in addition to code for primary procedure).
• 93653, Comprehensive electrophysiologic evaluation including insertion and repositioning of multiple electrode catheters with induction or attempted induction of an arrhythmia with right atrial pacing and recording, right ventricular pacing and recording, His recording with intracardiac catheter ablation of arrhythmogenic focus; with treatment of supraventricular tachycardia by ablation of fast or slow atrioventricular pathway, accessory atrioventricular connection, cavo-tricuspid isthmus or other single atrial focus or source of atrial re-entry
• 93654, … with treatment of ventricular tachycardia or focus of ventricular ectopy including intracardiac electrophysiologic 3D mapping, when performed, and left ventricular pacing and recording, when performed
• +93655, Intracardiac catheter ablation of a discrete mechanism of arrhythmia which is distinct from the primary ablated mechanism, including repeat diagnostic maneuvers, to treat a spontaneous or induced arrhythmia (List separately in addition to code for primary procedure)
• 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 possible, right ventricular pacing/recording when possible, His bundle recording when possible with intracardiac catheter ablation of atrial fibrillation by pulmonary vein isolation
• +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 procedure).

In fact, the +93623 deletions make up about half of all the deletions in CCI 19.2, according to the NCCI 19.2 Analysis by Frank Cohen, of Frank Cohen Group.

See How CPT® and CMS Changes Line Up

These edit deletions bring CCI policy closer to CPT^® guidelines, which were updated in March. Note that the updated CPT^® guidelines have an effective date of Jan. 1, 2013.

As the Heart Rhythm Society (HRS) explains, CCI opted to wait to make corrections until the CPT^® changes were official. You can see those CPT^® changes in the 2013 errata document posted at www.ama-assn.org/ama/pub/physician-resources/solutions-managing-your-practice/coding-billing-insurance/cpt/about-cpt/errata.page.

CCI then revised the edits as soon as its software logistics would allow, which was July 1. You can view HRS postings about the CCI changes at www.hrsonline.org/Practice-Guidance/Coding-Reimbursement/Coding.

The CPT^® changes most connected to these CCI deletions include a revision to the definition of Ablation, found in the guidelines for “Intracardiac Electrophysiologic Procedures/Studies.” As part of the revision, CPT^® added the underlined text and deleted the crossed out text:  “93623 may be reported separately with 93653-93657 93656 for treatment of atrial fibrillation.” Also, the note under +93623 added 93653, 93654, and 93656 to the list of appropriate primary codes.

Bonus tip: The errata document includes several additional corrections to CPT^® that you don’t want to miss:

• Ablation’s definition added the following text, which supports the use of 93656 without modifier 52 (Reduced services) even if all the pacing/recording components are not performed:  93656 includes each of left atrial pacing/recording, right ventricular pacing/recording, and His bundle recording when clinically indicated. When performance of one or more components is not possible or indicated, document the reason for not performing.
• The note under 3D mapping code +93613 was revised to add that you may use the code with 93656 as well as the already listed 93653 and EP study code 93620.
• The descriptor for 93656 was revised to add the underlined text and delete the crossed out text: Comprehensive electrophysiologic evaluation including transseptal catheterizations, insertion and repositioning of multiple electrode catheters with induction or attempted induction of an arrhythmia with including left or right atrial pacing/recording and pacing, when possible, right ventricular pacing/recording when possible and recording, His bundle recording when possible with intracardiac catheter ablation of arrhythmogenic focus, with treatment of atrial fibrillation by ablation by pulmonary vein isolation.