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Transseptal access

Riyaz Posted Thu 24th of January, 2013 20:52:39 PM

Is there a cpt code for transseptal access to ablate lateral pathway? Our physician performed comprehensive EP study with ablation for SVT, plus transseptal puncture, plus intracardiac echo, plus LA pacing, plus 3D mapping, plus adenosine administration. This year they had combined a lot of codes. What codes would cover this procedure?

SuperCoder Answered Mon 28th of January, 2013 12:06:03 PM

The new codes can definitely be confusing because although they seem similar, they differ in what services may be additionally reported. You can check Medicare’s pairings of primary and add-on codes at https://www.cms.gov/Regulations-and-Guidance/Guidance/Transmittals/Downloads/R2636CP.pdf.

Here are codes to consider checking against your complete documentation.

COMPREHENSIVE EP STUDY WITH ABLATION FOR SVT

93653, 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, His recording 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
Notes: (Do not report 93653 in conjunction with 93600- 93603, 93610, 93612, 93618- 93620, 93642, 93654)

PLUS TRANSSEPTAL PUNCTURE
+93462, Left heart catheterization by transseptal puncture through intact septum or by transapical puncture

PLUS INTRACARDIAC ECHO
+93662, Intracardiac echocardiography during therapeutic/diagnostic intervention, including imaging supervision and interpretation

PLUS LA PACING
Some might argue for +93621, 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, but payers may say that code is only appropriate with 93620

PLUS 3D MAPPING,
+93613, Intracardiac electrophysiologic 3-dimensional mapping

PLUS ADENOSINE ADMINISTRATION – check documentation carefully, but it probably falls under this quote from the CCI manual: “CPT code 93623 (programmed stimulation and pacing after intravenous drug infusion) is an add-on code that may be reported per CPT Manual instructions only with CPT codes 93619 or 93620 (comprehensive electrophysiologic evaluation). CPT code 93623 should not be reported for injections of a drug with stimulation and pacing following an intracardiac catheter ablation procedure (e.g., CPT codes 93650-93657) to confirm adequacy of the ablation. Per CPT Manual instructions, CPT code 93623 is not intended to be reported with the intracardiac catheter ablation procedure codes, and confirmation of the adequacy of ablation is included in the intracardiac catheter ablation procedure.”

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