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Cardiology Coding Alert

Commentary:

Views Differ on Coding Ablation with Transseptal Puncture

Published on Mon Apr 01, 2002

The debate continues over whether to code both 93651 (Intracardiac catheter ablation of arrhythmogenic focus; for treatment of supraventricular tachycardia by ablation of fast or slow atrioventrucular pathways, accessory atrioventricular connections or other atrial foci, singly or in combination) and CPT 93527 (Combined right heart catheterization and transseptal left heart catheterization through intact septum [with or without retrograde left heart catheterization]) or just 93651, after it was first introduced in the February 2002 issue of Cardiology Coding Alert ("Modifier Is Key for Ablation with Transseptal Puncture Reimbursement").
 
The North American Society of Pacing and Electrophysiology (NASPE) recommends billing both when a transseptal approach is chosen over a retrograde aortic approach. NASPE also instructs physicians who bill Medicare carriers to append modifier -59 (Distinct procedural service) to 93651.
 
The Society goes on to say, "NASPE's recommendations for coding the ablation procedure with transseptal puncture are based on the consensus process of over two dozen physicians and professional coders throughout the country. Also, use of 93527 should comply with all aspects of reporting and performance of catheterization including pressure measurements. NASPE has consulted the American College of Cardiology  (ACC) and the American Medical Association on this issue, and they both agree that NASPE's recommendations are accurate. The ACC recommends to members in its Guide to CPT Codes 2002 that use of 93527 is an appropriate way to code for cardiac ablations with a transseptal approach."
 
However, the consultant quoted in the article, Nikki Vendegna, CPC, Overland Park, Kan., cautions against this practice, as do several other coding experts interviewed.
 
Coders should remember that getting paid does not always mean the session was coded correctly.
 
You should check with your local carrier regarding the aforementioned recommendations to determine its coding preference and get its policy in writing.

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