Redo Atrial Fibrillation Ablation CodingIt is not unusual for patients to undergo redo ablation procedures after pulmonary vein isolation fails to be effective. In many cases, the redo procedure should be billed the same way as the initial procedure. In these cases, payment will be the same. In other cases, coding and reimbursement will be different.
Initial atrial fibrillation ablation procedures are most commonly performed with the goal of achieving isolation of the pulmonary veins. These procedures are commonly reported with codes 93656, 93662, 93613, and 93623. The first code includes pulmonary vein isolation, left atrial pacing and recording, transseptal puncture, and whatever components of a diagnostic EP study are necessary. The other codes are for intra-cardiac echo, mapping, and drug infusion, respectfully. Drug infusion is not always performed but it is billable when it is performed for diagnostic purposes. Redo procedures that also involve isolating the pulmonary veins should be reported the same way. But redo procedures that entail focal or linear ablations that are not intended to isolate the pulmonary veins should be reported differently. This is because the definition of code 93656 specifies, “treatment of atrial fibrillation by pulmonary vein isolation.” AF ablation procedures that are not performed to isolate the pulmonary veins should be reported as supraventricular tachycardia ablations rather than pulmonary vein isolation. SVT ablation procedures should be reported with code 93653. While this code generates quite a bit less compensation than the pulmonary vein isolation code, it does not have as many procedural components bundled into it. Because of this, trans-septal puncture and left atrial pacing and recording can be reported in addition to the SVT ablation, ICE, mapping, and drug infusion. Redo pulmonary vein isolation (93656, 93662, 93613, & 93623) generates 32.41 work RVUs. Reporting SVT ablation, ICE, trans-septal puncture, left atrial pacing and recording, mapping, and drug infusion generates 33.22 work RVUs (2.5% more than redo pulmonary vein isolation). But that’s not all... The SVT ablation code definition illustrates that there may be opportunity to generate additional compensation. The definition reads, “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.” Because of the singularity referenced in code 93653’s definition, cases that include ablations of multiple targets qualify for additional compensation. To secure this compensation, report code 93655 for each additional target after the first. A “Medically Unlikely Edit” caps the number of times code 93655 should typically be reported at two. However, with 7.5 assigned wRVUs, proper reporting of 93655 adds up quickly. Reporting this code twice, in addition to those mentioned above, brings the total wRVUs to 48.22. That’s 49% more than the initial pulmonary vein isolation! |
93613 - ($415.59 - 6.99) Intracardiac electrophysiologic 3-dimensional mapping (List separately in addition to code for primary procedure)
93655 – ($445.38 – 7.5 wRVUs) 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)
93462 – ($218.56 – 3.73 wRVUs) Left heart catheterization by transseptal puncture through intact septum or by transapical puncture (List separately in addition to code for primary procedure)
93621-26 – ($122.74 – 2.1 wRVUs) Comprehensive electrophysiologic evaluation including insertion and repositioning of multiple electrode catheters with induction or attempted induction of arrhythmia; with left atrial pacing and recording from coronary sinus or left atrium (List separately in addition to code for primary procedure)
93623-26 - ($166.52 - 2.85 wRVUs) Programmed stimulation and pacing after intravenous drug infusion (List separately in addition to code for primary procedure)
93653 – ($873.89 – 14.75 wRVUs) 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 (when necessary), and His bundle recording (when necessary) 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
93655 – ($445.38 – 7.5 wRVUs) 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 – ($1,174.28 - 19.77 wRVUs) Comprehensive electrophysiologic evaluation including transseptal catheterizations, insertion and repositioning of multiple electrode catheters with induction or attempted induction of an arrhythmia with atrial recording and pacing, when possible, right ventricular pacing and recording, His bundle recording with intracardiac catheter ablation of arrhythmogenic focus, with treatment of atrial fibrillation by pulmonary vein isolation.
93662-26 – ($146.78 – 2.80 wRVUs) Intracardiac echocardiography during therapeutic/diagnostic intervention, including imaging supervision and interpretation (List separately in addition to code for primary procedure)
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