Electrophysiology procedures are gaining significant recognition in the US. The total count of such procedures in the US was 1,485,763 in 2022. These are complex cardiac procedures for the diagnosis and treatment of abnormal heart rhythms. But do you know what really adds to the complexity of electrophysiology procedures? Their insurance billing!
One of the prominent electrophysiology billing codes is CPT code 93656. This guide was specifically put together to cover the code description, its applicable practical scenarios, and other important details, ensuring the submission of error-free claims.
By the end of this guide, you will have all the necessary information required to secure reimbursement for this vital procedure. So, let’s start.
CPT Code 93656 – Description
CPT code 93656 refers to a complete intracardiac electrophysiologic (EP) study with a catheter ablation procedure, pulmonary vein isolation (PVI) technique, to treat atrial fibrillation (AFib).
If we dive deeper into the details, it is a cardiac study where the provider places wire electrodes in the heart to measure electrical activity. He cuts the thin wall between the heart chambers to access the necessary sites and induces, or attempts to cause, arrhythmia.
Additionally, the provider also uses radiofrequency energy to treat the source of AFib (irregular heartbeat) around the connection of the pulmonary veins to the left atrium. The objective of this procedure is to restore a normal heart rhythm and enhance the patient’s overall cardiac function.
Appropriate Use Cases for CPT Code 93656
Here are a few examples of how CPT code 93656 should be used.
Paroxysmal AFib
Assume that a 55-year-old man visits his cardiologist because he has been experiencing shortness of breath, ongoing palpitations, lightheadedness, and irregular heartbeat for a week now. He further adds that despite treatment with beta blockers and an antiarrhythmic medication, the symptoms persist and significantly affect daily activities.
The cardiologist diagnoses paroxysmal atrial fibrillation (episodes start and stop suddenly) through his ECG. So, he recommends the patient undergo an EP study with pulmonary vein isolation. Since the primary goal of the procedure is to treat atrial fibrillation by blocking abnormal electrical signals from triggering arrhythmia, CPT code 93656 may be reported.
Post-COVID-19 AFib
Suppose a 60-year-old patient experiences persistent atrial fibrillation after recovering from COVID-19. It persists even after using rate and rhythm control drugs. Pulmonary vein triggers are confirmed by electrophysiologic examination. The patient receives intracardiac mapping, ablation, and catheter-based pulmonary vein isolation. CPT code 93656 is correctly reported because the treatment is carried out to treat atrial fibrillation by isolating the pulmonary veins.
Modifiers to Append with CPT Code 93656
Here are some modifiers that may apply to CPT code 93656. However, you must append them according to the situation and provide a written justification for their usage in the supporting documents.
Modifier 22
Apply modifier 22 to CPT code 93656 if the procedure was significantly more complex, time-consuming, or difficult than usual.
Modifier 52
Using modifier 52, representing reduced services, with CPT code 93656 indicates the physician intentionally performed a partial EP study/ablation, like only one vein or a diagnostic-only EP study without ablation. Since the core service wasn’t fully completed as planned, the biller must append this modifier with clear documentation explaining why it was reduced and what components were performed.
Modifier 73
Modifier 73 may be used with code 93656 if the procedure was stopped before administering anesthesia due to a serious change in the patient’s condition. However, this modifier is only applied by Ambulatory Surgical Centers (ASCs) and hospital outpatient facilities.
Modifier 74
When the procedure is stopped after the administration of anesthesia in an outpatient hospital or Ambulatory Surgery Center (ASC) facility setting, modifier 74 can be used with CPT code 93656. However, this modifier cannot be used by a physician as it is a facility modifier.
Reimbursement Guidelines for CPT Code 93656
To increase the clean claim rate for your cardiac electrophysiological studies and procedures, you must be aware of the billing and reimbursement guidelines for CPT code 93656.
Understand the Documentation Requirements
Pulmonary vein isolation catheter ablation is a comprehensive procedure with a substantial reimbursement amount. For correct reimbursement, insurance payers, including Medicare, need thorough paperwork. We advise you to include the following information with your CPT code 93656 claims:
- Evidence of atrial fibrillation symptoms.
- Patient symptoms (e.g., palpitations, dyspnea, fatigue) with the appropriate ICD-10 codes.
- Impact on daily activities.
- Relevant past medical history and comorbidities.
- Records of antiarrhythmic medication trials, intolerances, and contraindications.
- ECG monitoring that provides objective proof of the impact of atrial fibrillation.
- Evaluation of anticoagulant status, stroke risk, ventricular function, and structural heart disease.
Be Wary of the Bundled Services
CPT code 93656 corresponds to a fairly complete procedure. It includes various procedures that are not reimbursable independently. Some of the services included with 93656 are as follows:
- 3D mapping to guide the procedure (CPT code 93613).
- Intracardiac echocardiography ICE (CPT code 93662).
- Pulmonary vein isolation
- Left atrial pacing and recording (CPT code 93621)
Final Thoughts on CPT Code 93656
A complex electrophysiological procedure is billed using CPT code 93656. The goal of this EP study and catheter ablation technique is to treat atrial fibrillation.
Along with your claims, you must include comprehensive documentation and, if necessary, include the appropriate modifiers (22, 52, 73, and 74).
However, you may want expert assistance if you continue to receive claim denials despite adhering to the billing requirements. At NeuraBill, our professionals provide specialized cardiology billing services that are sure to lower your denial rates.
