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).
Hi,
I have a question for Jim Collins regarding his Volume 13 issue 1 January 13 Changes Coming for 2013 CPT codes. I have advised our EP physicians not to report 93623 with the new ablation cpt codes. Would this be correct?
The newly updated Revision Date 1/1/2013 Chapter XI Medicine National Correct Coding Initiative, page XI- 20, # 29. (states) 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.
Reply to this comment »The new CCI publication cements in three errors in the CPT framework. By validating the previously considered parenthetical note errors in CPT which excluded the ablation codes (93650-93657) from the applicable base codes for the add-on procedures (93621-93623) CCI has essentially made it inappropriate to report LA pacing/recording, LV pacing/recording, and Isuprel infusion at the time of an ablation. Therefore, it is correct to tell your providers to not report these services separately.
Reply to this comment »Jim:
So if this is an error on CPT's part, which it sounds like it is, is CCI edits going to correct their edit so that we can bill 93621-93623 eventually? Will we ever be able to report these codes with the ablation codes 93650-93657.
I'm confused at this whole mess CPT has created.
Thanks Jim.....
Reply to this comment »Since the NCCI manual was updated to re-enforce the parenthetical notes, I do not anticipate that the CCI edits will reverse/correct them. This effectively makes it inappropriate to report 93621 - 93623 with the new ablation codes. Jim.
Reply to this comment »Hi Jim,
Reply to this comment »Thank you for your article and insights into EP. This was a very helpful article and I direct my clients to it daily. I have a question based on the thread above, that I would like to run by you because I am also seeing that CPT and CCI have some conflicting instructions. I get that the code 93621 is bundled into the ablation codes. But my question is regarding the 93623 for the programmed stimulation during the 93656 ablation for Afib. The CPT book (page 519 2013 Prof edition second to last paragraph) states, "...codes 93622 and 93623 may be reported separately with 93656 for treatment of afib...." and there is a -59 modifier edit allowed for the 93623. Also the parenthetical codes underneath the 93656 does not exclude the 93623 from being coded with 93656. BUT, and there always a but, I am seeing this being denied when coded with the ablation code.
Do you see a scenario when it is appropriate to code for it with an SVT or VT ablation? Medicare or non-Medicare.
Thanks for your response in advance.
Jim,
Reply to this comment »What code would be appropriate to use for an aflutter ablation?
CMS Transmittal 2636, with an effective date of April 1, 2013, will put an end to separate payment for five common add-on services in the electrophysiology world. The 2013 codes for ablation bundle the work of a diagnostic EP study in with the work of the ablation. However, CPT instructions made it clear that mapping and other common add-on services could be reported in addition to the composite ablation codes. Consider the following excerpts from CPT 2013:
“Mapping is a distinct procedure performed in addition to a diagnostic electrophysiology study or ablation procedure and may be separately reported using 93609 or 93613.”
“Codes 93622 and 93623 may be reported separately with 93656 for treatment of atrial fibrillation.”
Although CPT says that we can bill these four services with the new ablation codes, Transmittal 2636 establishes otherwise. The transmittal classifies add-on codes into different Types. The add on codes for 2D mapping (93609), 3D mapping (93613), LA pace/record (93621), LV pace/record (93622), and drug infusion followed by induction attempts (93623) are each categorized as “Type I” add-on services.
According to the transmittal, “A Type I add-on code has a limited number of identifiable primary procedure codes. The CR lists the Type I add-on codes with their acceptable primary procedure codes… Claims processing contractors must adopt edits to assure that Type I add-on codes are never paid unless a listed primary procedure code is also paid.”
The transmittal also lists which specific primary procedure codes are recognized for payment purposes. The table summarizes our five add-on services in the following way:
93609 is reported with 93620, 93653
93613 is reported with 93620, 93653
93621 is reported with 93620
93622 is reported with 93620
93623 is reported with 93619, 93620
Other than being able to report mapping (93609 or 93613) with the new SVT ablation code (93653), we should not be reporting any of these five add-on services with any of the new ablation codes. This represents a substantial reduction in reported RVUs and the associated revenue.
A CMS representative confirmed that Medicare rule can override CPT instruction and alluded to the potential for additional clarification from the AMA with the following comment, “there may be additional guidance from the AMA on both issues shortly. If there is not, CMS usually goes with the published CPT guidance unless there is a Medicare rule that contravenes the guidance.”
In addition to Transmittal 2636, the Correct Coding Initiative Policy Manual (Chapter XI) also contravenes CPT instruction. The CCI publication states the following, “Per CPT Manual instructions, CPT code 93623 is not intended to be reported with the intracardiac catheter ablation procedure codes”.
All things considered, this appears to be pretty conclusive. CMS instructions override CPT instructions and CMS says we cannot report these add-on services with the new ablation codes.
Reply to this comment »Jim,
My physician has asked for the code for Isuprel Challenge. Would you please help me to accurately bill for this.
Many thanks,
Reply to this comment »Sharon
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