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. These bundling updates by CMS eliminate separate payment when performed with supraventricular tachycardia (SVT) ablation – 93653 and atrial fibrillation (A-Fib) ablation – 93656. These services include:

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

As a result of these coding updates, the following add-on coding combinations are now bundled into the primary EP & ablation procedure that could have been billed separately before. In this article we shall discuss these updates and what they entail for the coding of EP procedures moving forward.

Let’s start with updated description of these codes:

  • 93653: Comprehensive electrophysiologic evaluation with insertion and repositioning of multiple electrode catheters, induction or attempted induction of an arrhythmia with right atrial pacing and recording, and catheter ablation of arrhythmogenic focus, including intracardiac electrophysiologic 3-dimensional mapping, right ventricular pacing and recording, left atrial pacing and recording from coronary sinus or left atrium, and His bundle recording, when performed 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.
  • 93656: Comprehensive electrophysiologic evaluation including transseptal catheterizations, insertion and repositioning of multiple electrode catheters with intracardiac catheter ablation of atrial fibrillation by pulmonary vein isolation, including intracardiac electrophysiologic 3-dimensional mapping, intracardiac echocardiography including imaging supervision and interpretation, induction or attempted induction of an arrhythmia including left or right atrial pacing/recording, right ventricular pacing/recording, and His bundle recording, when performed.

76937 has also gone through some Updates:

Separate Ultrasound guidance is now also bundled into EP procedures:

  • Following this trend, “Ultrasound guidance - 76937” is also being bundled in 33202-33275 and 93600-93662 as per updated guidelines. Providers/suppliers shall not report CPT codes 76937, 76942, 76998, 93318, or other ultrasound procedural codes if the ultrasound procedure is performed for guidance during one of the procedures described by CPT codes 33202-33275 or 93600-93662.

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

  • Supraventricular tachycardia (SVT) ablation (CPT code 93653) will include 3D mapping (93613) and left atrial pacing and recording (93621)
  • Ventricular tachycardia (VT) ablation (CPT code 93654) will include left atrial pacing and recording (93621)
  • Pulmonary Vein Isolation (PVI) ablation for AF (CPT code 93656) will include Intracardiac Echocardiography (ICE) (93662) and 3D mapping (93613)

Try to keep in mind the following table for cross-checking EP coding combinations for whenever they are billed at your Practice. This table can help simplify coding scenarios where you can unbundle and bill the 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.

Following these Bunding updates, make sure you don’t bill services which are already inherent to the EP procedure and secondly avoid the coding combinations which can lead to bundling ambiguities. It is vital to go through the medical documentation following these updates. This will give an idea to which services were performed that can in turn make it easier to un-bundle these EP procedures, using appropriate modifiers.

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