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What is the latest Electrophysiology Code Bundling update that a Medical Coder needs to be aware of?

2022 Medicare Physician Fee Schedule final rule reports some changes in Electrophysiology codes. CMS bundled SVT and A-Fib add-ons, eliminating separate payments, effective January 1, 2022. These services include:

  • 3D mapping – 93613
  • Left-atrial pacing – 93621
  • Intracardiac echocardiography (ICE) – 93662

Coding updates bundle add-on procedures into primary EP & ablation procedures. This article discusses EP coding updates & their impact on procedure coding going forward.

Let’s start with updated description of these codes

  • 93653: Comprehensive EP evaluation with multiple catheters, 3D mapping, and SVT ablation.
  • 93656: Comprehensive EP evaluation with transseptal cath, AF ablation, and 3D mapping.

76937 has also gone through some Updates

Separate Ultrasound guidance is now also bundled into EP procedures:

  • Ultrasound guidance (76937) is bundled with EP procedures (33202-33275, 93600-93662) per updated guidelines. Do not bill ultrasound codes separately for guiding EP procedures 33202-33275 or 93600-93662.

The coding combinations that you should look for while coding EP procedures:

  • SVT ablation (93653) now includes 3D mapping (93613) and LA pacing/recording (93621).
  • VT ablation (93654) now includes LA pacing and recording (93621).
  • PVI ablation (93656) now includes ICE (93662) and 3D mapping (93613).

Cross-check EP coding combinations using this table. This table simplifies when to unbundle and bill EP procedures separately.

Inherent:

Means the service is already part of the Primary code and there is no need to bill it separately.

Bundled:

Means the service is packaged into the Primary code and cannot be billed separately.

Not Bundled:

Means you may bill this service separately by appending appropriate Modifiers. i.e., 51 or 59.

Avoid billing services inherent to EP procedures and ambiguous combinations. It is vital to go through the medical documentation following these updates. Un-bundling EP procedures with modifiers.

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