Changes Coming for 2013 CPT Codes
- Volume 13 - Issue 1 - January 2013
- Posted on: 1/3/13
- 8 Comments
- 15919 reads
The 2013 CPT codes have been finalized; brace for an overhaul in the way you report ablation procedures effective January 1st. Gone are the codes we’ve used for eons to report all SVT and VT ablations — in their place are monolithic beasts which must be conquered to secure full reimbursement for future ablations.
Code 93651 is currently used to report all supraventricular tachycardia ablations. This service is typically reported in addition to a diagnostic EP study and mapping of some sort. Left atrial pacing and recording (93621), Isuprel infusion (93623), and intracardiac echo (93662) are occasionally reported at the time of an SVT ablation.
The biggest problem with code 93651 is that it encompasses all forms of SVT ablation without providing additional credit for complex ablations like atrial fibrillation ablation, arrhythmias originating from multiple focal points, or procedures requiring the interruption of multiple pathways.
CPT 2013 partially fixes this problem by including five new codes that can be used to report ablation procedures in a way that permits more precise reporting of complex procedures. However, the new codes include a lengthy “honey do” list of procedural components that must be performed and documented in order to secure whatever premium payers decide to grant ablation procedures. If we fail to hit every checkbox on the list, it will be necessary to attach the reduced service modifier (52) to the new ablation codes and risk substantial payment reduction.
From the mile-high view, you’ll see four codes available to report basic ablation procedures in 2013. The AV node ablation procedure code (93650) is the same as it ever was — no changes here. However, code 93656 stands out as the new atrial fibrillation ablation code. This is an “all in one” code intended to encompass the full scope of the procedure — kind of. But to report it, you must perform and document each of the listed procedural components. Here they are:
- Multiple transseptal catheterizations
- Induction or attempted induction of an arrhythmia
- Right and left atrial pacing (when possible)
- Right and left atrial recording (when possible)
- Right ventricular pacing
- Right ventricular recording
- His bundle recording
- Pulmonary vein isolation
If any of these procedural components are missing from your documentation, it will be necessary to report 93656-52 — the dreaded 52 modifier forces the claim to be manually priced by payers (long payment delay and reduced compensation).