Cardiology Coding Alert

Question: My cardiologist performed an ablation procedure during the same session as an electrophysiology (EP) study. I was looking through my CPT^® code choices, and it looks like I need to read my cardiologist’s medical documentation carefully to identify the type of arrhythmia he was treating. Can you explain the differences between these procedure codes?

Maine Subscriber

Answer: When your cardiologist performs an ablation procedure during the same session as an EP study, you can choose from the following codes:

• 93653 (Comprehensive electrophysiologic evaluation with insertion and repositioning of multiple electrode catheters, induction or attempted induction of an arrhythmia with right atrial pacing and recording and catheter ablation of arrhythmogenic focus, including intracardiac electrophysiologic 3-dimensional mapping, right ventricular pacing and recording, left atrial pacing and recording from coronary sinus or left atrium, and His bundle recording, when performed; 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) and 93654 (… with treatment of ventricular tachycardia or focus of ventricular ectopy including left ventricular pacing and recording, when performed)
• 93656 (Comprehensive electrophysiologic evaluation including transseptal catheterizations, insertion and reposi­tioning of multiple electrode catheters with intracardiac catheter ablation of atrial fibrillation by pulmonary vein isolation, including intracardiac electrophysiologic 3-dimensional mapping, intracardiac echocardiography including imaging supervision and interpretation, induction or attempted induction of an arrhythmia including left or right atrial pacing/recording, right ventricular pacing/ recording, and His bundle recording, when performed)

The differences between the above codes lie in what type of arrhythmia your cardiologist treated.

For example, you should report code 93653 when your cardiologist performs catheter ablation to treat supraventricular tachycardia caused by dual atrioventricular nodal pathways, accessory atrioventricular connections, or other atrial foci.

On the other hand, you should report code 93654 if your cardiologist performs catheter ablation to treat ventricular tachycardia or focus of ventricular ectopy.

Finally, you should report code 93656 when your cardiologist performs ablation to treat atrial fibrillation with the goal of completing pulmonary vein electrical isolation.