2017 is going to see a number of new codes and guideline revisions, which includes Cardiology’s Catheter Ablation Coding. Similar to past years, these new codes have been prepared due to changes in 2017 Electrophysiological Coding Documentation. New codes will be introduced, that aren’t currently a part of the CPT® code set, and additionally, there will be extension of some code categories as well.
Catheter Ablation is a therapeutic technique using tripolar electrode catheter which uses tachycardia to eliminate conduction defects. Involving a lot of high level current channelized through catheter to destroy heart’s arrhythmic area, it treats supraventricular tachycardia by ablation or modulating atrio-ventricular tachycardia or ablating accessory conduction pathways. Ventricular tachycardia is treated by ablating arrhythmogenic focus, which is an alteration to open heart surgical techniques. Catheter ablation is an acceptable alternative to long-term drug therapy, and its role is to provide primary therapy for several arrhythmias described in technology assessments or position papers by the American Medical Association and other institutes.
Catheter Ablation Coding
Once the physician has identified the locations where the arrhythmia is originating, these areas can be ablated (destroyed) by means of radiofrequency or cryotherapy. Code assignment is the same regardless of which technique is used. Depending upon the location of the arrhythmia, it may be necessary to place catheters into the coronary sinus or left side of the heart.
Reporting of EP Studies/Ablations
Reporting of ablations with pre-EP studies have been streamlined and all new catheter ablation codes include the comprehensive EP study + treatment.
Ablation Coding
| CPT® Code | Definition |
| 93653 | Ablation SVT (Dual AV nodal pathways, accessory AV connections, other atrial foci). |
| 93654 | Ablation of ventricular tachy or focus of ventricular ectopy including 3D mapping and left ventricular pacing when performed. |
| 93656 | Ablation of atrial fibrillation including transeptal catheterizations….by pulmonary vein isolation (PVI). |
Per CPT® the above codes are distinct primary services and may not be reported together. Mapping is a distinct procedure and may be reported separately with atrial ablation procedures. VT ablation (93654) includes mapping. Code 93650 still exists for Atrial Flutter Ablation (93653 also for Aflutter).
Ablation Add-On Codes
| CPT® Code | Definition |
| + 93655 | Additional ablation procedure of arrhythmia distinctly separate from primary ablated mechanism (includes any repeat diagnostic maneuvers). Reported with: 93656 (SVT), 93654 (VT), 93656 (afib)- not reported for treatment of another atrial fibrillation mechanism. |
| + 93657 | Additional linear or focal intracardiac catheter ablation of the left or right atrium for treatment of atrial fibrillation remaining after completion of pulmonary vein isolation. Reported with: 93656 when: ü Successful pulmonary vein isolation is achieved ü Attempts at re-induction of atrial fibrillation find another focus of afib ü Further ablation of the new mechanism is performed. ü These codes can be billed more then once during the same encounter
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For more on catheter ablation coding, CPT® 2017 cardiology coding, and EP coding and documentation you may attend the Coding Updates Virtual Bootcamp 2016 (Nov 30 – Dec 2) to get the latest updates cardiology coding from expert speaker Terry Fletcher. Don’t miss this year’s biggest virtual event on cardiology coding.
