CATHETER ABLATION CODING & REIMBURSEMENT GUIDE. Updated September 2018
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1 CATHETER ABLATION CODING & REIMBURSEMENT GUIDE Updated September 2018
2 TABLE OF CONTENTS Diagnosis Codes...3 ICD-10-CM Diagnosis Codes Coverage for Catheter Ablation Procedures....4 Medicare Other Payers Physician Services Coding... 4,5 Catheter Ablation Diagnostic Electrophysiologic Study (EPS) Inpatient Hospital Coding....6 ICD-10-PCS Procedure Codes Medicare Severity Diagnosis Related Group (MS-DRG) Assignments Outpatient Hospital Coding.... 6,7 Comprehensive Ambulatory Payment Classification (C-APCs) Medicare Hospital Outpatient Catheter Ablation C-Code Listing For questions or for more information, please contact the Medtronic Cardiac Rhythm & Heart Failure Reimbursement Hotline at The coding suggestions and coding guidelines in this guide do not replace seeking coding advice from the payer and/or your own coding staff. The ultimate responsibility for correct coding lies with the provider of services. Please contact your local payer for interpretation of the appropriate codes to use for specific procedures. Medtronic makes no guarantee that the use of this information will prevent differences of opinion or disputes with Medicare or other third-party payers as to the correct form of billing or the amount that will be paid to providers of service. Where reimbursement is requested for the use of a product that may be inconsistent or not expressly specified in the FDA cleared or approved labeling (e.g., instructions for use, operator s manual, or package insert), consult with your billing advisors or payers for advice on handling such billing issues. Some payers may have policies that make it inappropriate to submit claims for such items or related services. 2 of 8 September 2018
3 DIAGNOSIS CODES ICD-10-CM 1 Diagnosis Codes that May Support Ablation Procedures The following is a list of diagnosis codes that may be associated with VT, SVT, and PVI ablation procedures. The list is for illustrative purposes only. Refer to the Instructions for Use supplied with a product for indications, contraindications, side effects, warnings, and precautions. ICD-10-CM 1 Diagnosis Code ICD-10-CM 1 Diagnosis Code Description I47.0 Re-entry ventricular arrhythmia I47.1 Supraventricular tachycardia (includes AVNRT) I47.2 Ventricular tachycardia I47.9 Paroxysmal tachycardia, unspecified I48.0 Paroxysmal atrial fibrillation I48.1 Persistent atrial fibrillation I48.2 Chronic atrial fibrillation I48.3 Typical atrial flutter (type I) I48.4 Atypical atrial flutter (type (II) I49.01 Ventricular fibrillation I49.02 Ventricular flutter I49.1 Atrial premature depolarization (premature atrial beats and contractions) I49.2 Junctional premature depolarization I49.3 Ventricular premature depolarization (premature ventricular contractions) I49.40 Unspecified premature depolarization (unspecified premature beats) I49.49 Other premature depolarization (includes ectopic beats) I49.5 Sick sinus syndrome (tachycardia-bradycardia syndrome) I49.8 Other specified cardiac arrhythmias I49.9 Cardiac arrhythmia, unspecified I48.91 Unspecified atrial fibrillation I48.92 Unspecified atrial flutter 3 of 8 September 2018
4 COVERAGE FOR CATHETER ABLATION PROCEDURES Medicare: Medicare has not issued national or local coverage determinations for catheter ablation services. The Social Security Act allows coverage and payment for only those services that are considered to be medically reasonable and necessary. 2 The medical necessity for services provided must be documented in the medical record. Other Payers: We recommend that you contact the patient s insurance company for guidance on what specific codes are required for catheter ablation procedures as part of your request for a prior authorization or a predetermination. PHYSICIAN SERVICES CODING Significant changes were made to the CPT codes for catheter ablation procedures for services performed on and after January 1, Both the catheter ablation and electrophysiological study (EPS) aspects of the procedure are reflected in these catheter ablation codes. In some instances, the catheter ablation and EPS procedures are no longer considered distinct procedures and therefore not reportable with separate codes. Some of the CPT 3 codes used to describe EP diagnostic and cardiac catheter ablation procedures, as well as mapping procedures, which may sometimes be concurrently performed at physician s discretion, are listed below. Catheter Ablation: CPT 3 Code CPT 3 Code Description Intracardiac catheter ablation of atrioventricular node function, atrioventricular conduction for creation of complete heart block, with or without temporary pacemaker placement 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 (Do not report in conjunction with , 93610, 93612, , 93642, 93654, 93656) with treatment of ventricular tachycardia or focus of ventricular ectopy including intracardiac electrophysiologic 3D mapping, when performed, and left ventricular pacing and recording, when performed (Do not report in conjunction with , , , , , , 93622, 93642, 93653, 93656) Comprehensive electrophysiologic evaluation including transseptal catheterizations, insertion and repositioning of multiple electrode catheters with induction or attempted induction of an arrhythmia including left or right atrial pacing/recording when necessary, right ventricular pacing/recording when necessary and His bundle recording when necessary with intracardiac catheter ablation of atrial fibrillation by pulmonary vein isolation (Do not report in conjunction with , , 93462, 93600, , 93610, 93612, , ) National Physician Rate $ $ $1, $1, The ablation procedure codes 93650, 93653, and are distinct primary procedure codes and may not be reported together. Add-on codes and may be applicable when intracardiac catheter ablation of a discrete arrhythmia is performed after the treatment of the primary ablated mechanism 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 (Use in conjunction with , 93656) $ of 8 September 2018
5 CPT 3 Code CPT 3 Code Description 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 (Use in conjunction with 93656) Left heart catheterization by transseptal puncture through intact septum or by transapical puncture (Use in conjunction with 33477, , , 93582, ) (Do not report in conjunction with 93656) (Do not report in conjunction with 0345T unless transapical puncture is performed) When reporting ablation therapy codes ( ), comprehensive EP studies may not be separately reported. Diagnostic Electrophysiologic Study (EPS): National Physician Rate $ $ Coding information to be used when a physician performs a diagnostic electrophysiologic study (EPS) prior to a catheter ablation on a diffrent DOS. CPT 3 Code CPT 3 Code Description Comprehensive electrophysiologic evaluation with right atrial pacing and recording, right ventricular pacing and recording, His bundle recording, including insertion and repositioning of multiple electrode catheters, without induction or attempted induction of arrhythmia (Do not report in conjunction with 93600, , 93610, 93612, 93618, , ) Comprehensive electrophysiologic evaluation including insertion and repositioning of multiple electrode catheters with induction or attempted induction of arrhythmia; with right atrial pacing and recording, right ventricular pacing and recording, His bundle recording (Do not report in conjunction with 93600, , 93610, 93612, , ) with left atrial pacing and recording from coronary sinus or left atrium (Use in conjunction with 93620, ) (Do not report in conjunction with 93656) with left ventricular pacing and recording (Use in conjunction with 93620, 93653, 93656) (Do not report in conjunction with 93654) Programmed stimulation and pacing after intravenous drug infusion (Use in conjunction with 93610, 93612, , , 93656) Intracardiac echocardiography during therapeutic/diagnostic intervention, including imaging supervision and interpretation (Use in conjunction with 92987, 93453, , 93532, , , , as appropriate) (Do not report in addition to 93662) Electrophysiologic follow-up study with pacing and recording to test effectiveness of therapy, including induction or attempted induction of arrhythmia National Physician Rate $ $ $ $ $ Carrier-priced $ Mapping is considered a distinct procedure performed in addition to a diagnostic EP study or ablation procedure and may be separately reported Intraventricular and/or intra-atrial mapping of tachycardia site(s) with catheter manipulation $ to record from multiple sites to identify origin of tachycardia (Use in conjunction with 93620, 93653, 93656) (Do not report in conjunction with 93613, 93654) Intracardiac electrophysiologic 3-dimensional mapping (Use in conjunction with 93620, 93653, 93656) (Do not report in conjunction with 93609, 93654) $ of 8 September 2018
6 INPATIENT HOSPITAL CODING ICD-10-PCS 4 Procedure Codes for Percutaneous Ablation Procedures ICD-10-PCS 4 Procedure Code 4A023FZ 02K83ZZ 02583ZZ ICD-10-PCS 4 Procedure Code Description Measurement of cardiac rhythm, percutaneous approach Map conduction mechanism, percutaneous approach Destruction of conduction mechanism, percutaneous approach Possible DRG Assignments (MS-DRG: Medicare Severity Diagnosis Related Group) MS-DRG Brief MS-DRG Description National Inpatient Rate 273 Percutaneous intracardiac procedures w/mcc $21, Percutaneous intracardiac procedures w/o MCC $16, MCC: Major complication or comorbidity OUTPATIENT HOSPITAL CODING Comprehensive Ambulatory Payment Classifications (C-APCs): CPT 3 Code Brief Description Electrophysiology eval w/o arrhythmia Electrophysiology eval w/ arrhythmia EP follow-up study AV node ablation SVT ablation and EP eval VT ablation and EP eval Ablation of AF by PVI with transseptal and EP evaluation National Hospital Outpatient Rate C-APC C-APC Description $5, Level 2 Electrophysiologic Procedures $18, Level 3 Electrophysiologic Procedures The following codes are not assigned to an APC as they are ancillary to the primary procedures. Medicare classifies the following codes with an N Status Indicator and does not separately reimburse hospitals for these procedures. Hospitals should report all applicable codes, including those for packaged services, according to correct coding principles Transseptal puncture (Use in conjunction with 33477, , , 93461, ) (Do not report in conjunction with 93656) (Do not report in conjunction with 0345T unless transapical puncture is performed) Intraventricular and/or intra-atrial mapping (Use in conjunction with 93620, 93653, 93656) (Do not report in conjunction with 93613, 93654) Intracardiac 3-dimensional mapping (Use in conjunction with 93620, 93653, 93656) (Do not report in conjunction with 93609, 93654) Comprehensive EP evaluation; with left atrial pacing and recording from coronary sinus or left atrium (Use in conjunction with 93620, ) (Do not report in conjunction with 93656) Comprehensive EP evaluation; with left ventricular pacing and recording (Use in conjunction with 93620, 93653, 93656) (Do not report in conjunction with 93654) 6 of 8 September 2018
7 Programmed stimulation and pacing after intravenous drug infusion (Use in conjunction with 93610, 93612, , , 93656) Additional ablation of discrete arrhythmia, SVT or VT (Use in conjunction with , 93656) Additional linear focal lesion for AF (Use in conjunction with 93656) Intracardiac echocardiography (Use in conjunction with 92987, 93453, , 93532, , , , as appropriate) (Do not report in addition to 93662) Medicare Hospital Outpatient Catheter Ablation C-Code Listing C1730 Catheter, Electrophysiology, Diagnostic, Other than 3D Mapping (19 or Fewer Electrodes) Device Torqr CS Diagnostic Catheter Model Number CS, CS, CS Torqr, Soloist Diagnostic Catheter JM, UM, DM, JM, UM, 04130DS, 04122JM, 04122UM, 04125JM, 04125UM, JF, U, 44216J, 44216JF, 44216U, 44516J, 44516JF, 44516U Marinr CS M, M, M Marinr , M, Achieve Mapping Catheter , Achieve Advance Mapping Catheter 2ACH15, 2ACH20, 2ACH25 C1731 Catheter, Electrophysiology, Diagnostic, Other than 3D Mapping (20 or More Electrodes) Device StableMapr Model Number 04401SM, 04402SM C1733 Catheter, Electrophysiology, Diagnostic/Ablation, Other than 3D or Vector Mapping, Other than Cool Tip Device Model Number RF Enhancr II , , , , RF Contactr , RF Conductr MC , , , , , , , RF Marinr MC , , , F RF Marinr , , , , , Freezor Cardiac CryoAblation Catheter Freezor MAX Cardiac CryoAblation Catheter Freezor Xtra Cardiac CryoAblation Catheter Arctic Front Advance Cardiac CryoAblation Catheter 307F1, 307F3, 307F5 239F3, 239F5 227F1, 227F3, 227F5 2AF234, 2AF284 C1766 Introducer/Sheath, Guiding, Intracardiac Electrophysiolgical, Steerable, Other than Peel-away Device FlexCath Advance Steerable Sheath Model Number 4FC12 7 of 8 September 2018
8 References 1 International Classification of Diseases, Tenth Revision, Clinical Modification. Accessed August 31, Social Security Act Section U.S.C. 1395y(a)(1)(A), is available at 3 Current Procedural Terminology (CPT) is 2015 American Medical Association. All Rights Reserved. No fee schedules, basic units, relative causes or related listings are included in CPT. The AMA assumes no liability for the data contained herein. Applicable FARS/DFARS Restrictions Apply to Government Use. Fee schedules, relative value units, conversion factors and/or related components are not assigned by the AMA, are not part of CPT, and the AMA is not recommending their use. The AMA does not directly or indirectly practice medicine or dispense medical services. The AMA assumes no liability for the data contained or not contained herein. 4 International Classification of Diseases, Tenth Revision, Procedure Coding System. Accessed August 31, Medtronic 710 Medtronic Parkway Minneapolis, MN USA Toll-free in USA: Worldwide: medtronic.com UC e EN 2018 Medtronic. Minneapolis, MN. All Rights Reserved. Printed in USA. 09/2018
Electrophysiology. Jim Collins, CPC, CCC President, CardiologyCoder.Com, Inc. Two Types of Diagnostic EP Studies
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