Wiki 93657 additional ablation codes

[armstrong]

I am wondering what the original intent of the code should be. Code 93657 is ea add?l linear or focus ablation. There are 4 pulmonary veins that enter the left atrium. If ablation was done in each one, RIPV, RSPV, LIPV, & LSPV plus a roof line, would that count as a total of 5, 93656, 93657 x 4 or are the pulmonary veins always considered as 1, 93656, 93657 x 1?

Medicare set the MUE to 1 for wach of these codes yet the 2014 ardioloy CPT update by Terry Fletcher stated that 93655 can have multiple units and 93657 could only have 1. This also disagrees with the last post form CPT assistant.

 

[twizzle]

I am wondering what the original intent of the code should be. Code 93657 is ea add?l linear or focus ablation. There are 4 pulmonary veins that enter the left atrium. If ablation was done in each one, RIPV, RSPV, LIPV, & LSPV plus a roof line, would that count as a total of 5, 93656, 93657 x 4 or are the pulmonary veins always considered as 1, 93656, 93657 x 1?

Medicare set the MUE to 1 for wach of these codes yet the 2014 ardioloy CPT update by Terry Fletcher stated that 93655 can have multiple units and 93657 could only have 1. This also disagrees with the last post form CPT assistant.

This is an add-on code to 93656. If the doctor does an a-fib ablation using PVI and afterwards a-fib persists, they will do a further a-fib ablation elsewhere in the atrium. That is when you bill 93657.

In an ideal word the doctor needs to say 'a-fib persisted after ablation therefore additional lines were drawn in the posterior wall', or whever.
You cannot bill it multiple times. You can bill 93655 in addition to 93656 and 93657 if they also ablate a different tachycardia such as atrial flutter or atrial re-entrant tachycardia but you must use a different diagnosis, not a-fib.

 

[armstrong]

Why cant I bill 93657 more then once, the code reads ea additional. Is this based on the MUE of 1? Not all carriers follow MUE. Does anyone have documentation from the AMA on the units alalowed with this code?

 

[twizzle]

Why cant I bill 93657 more then once, the code reads ea additional. Is this based on the MUE of 1? Not all carriers follow MUE. Does anyone have documentation from the AMA on the units alalowed with this code?

You can bill 93657 as many times as you want despite a MUE of 1. As I said, your provider needs to document why he wants it billing 5 times or 7 times by using the format I suggested. Chances are payers would request records and I would bet good money they won't pay more than one, two at a push depending on insurance.