Cardiology Coding Alert

Question: How should I code if during an encounter the physician performs CTI ablation for atrial flutter before performing planned PVI for atrial fibrillation?

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Answer: In the July 2013 CPT^® Assistant, the AMA states that the chronological order of the ablations does NOT determine coding: “The primary arrhythmia is the clinical arrhythmia that the patient is being treated for.”

In the CPT^® Assistant question, the example is given of a patient who presents for atrial fibrillation ablation, but atrial flutter is induced and ablated first. Then pulmonary vein isolation (PVI) is performed for A-fib.

CPT^® Assistant states that the anticipated procedure is PVI, so regardless of chronological order, you should code the PVI using 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 necessary, right ventricular pacing/recording when necessary and His bundle recording when necessary with intracardiac catheter ablation of atrial fibrillation by pulmonary vein isolation).

Report the atrial flutter ablation using add-on code +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]).