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Tip of the Week: Choose AV ablation codes based on area of the heart, rhythm type

APCs Weekly Monitor, January 11, 2008

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With an ablation, the electrophysiologist is trying to disrupt the electrical pathway that's causing an abnormal rhythm by destroying the electrical tissues. "We want to alter or disrupt the pathway and see if we can't get rid of the impulses that are causing the pathway," says Linda Gates-Striby, CCS-P, ACS-CA, principal of Gates Physician Services in Indianapolis. This disruption will often return a normal electrical flow. An electrophysiologist will identify the pathway through the mapping processes.

"Think about it as connect the dots. Dot three is supposed to send [the signal] to four, but instead it sends it over to six or seven, so we need to get rid of that four if that was the dot that was causing the problem," says Gates-Striby.

Report the following codes to indicate ablation. Choose the specific code based on the area of the heart and the rhythm type:

• 93650-AV node ablation with or without temporary pacer
• 93651-Supraventricular tachycardia, access AV, or other atrial (refers to the two upper chambers of the heart)
• 93652-Ventricular tachycardia, access AV, or other atrial

AV node ablation is a procedure that destroys the AV node so that the atrial electrical discharges cannot pass through it to activate the ventricles.

With AV node ablation, there isn't typically a need to conduct a complete study or map, says Gates-Striby. Electrophysiologists already know what the problem is, and they know the procedure will create a complete heart block and a pacemaker will control the patient's rhythm.

Some electrophysiologists implant the pacemaker prior to the AV nodal ablation; others will implant the pacemaker in the same session as the AV nodal ablation. If a temporary pacemaker is used in the procedure, it is included in the AV nodal ablation itself and is not separately billable.

(The above tip was excerpted from the January issue of Briefings on APCs).

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