Updated September 2018

CATHETER ABLATION CODING & REIMBURSEMENT GUIDE

September 20182 of 8

TABLE OF CONTENTSDiagnosis Codes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3ICD-10-CM Diagnosis Codes

Coverage for Catheter Ablation Procedures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4MedicareOther Payers

Physician Services Coding . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4,5Catheter AblationDiagnostic Electrophysiologic Study (EPS)

Inpatient Hospital Coding . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6ICD-10-PCS Procedure CodesMedicare Severity Diagnosis Related Group (MS-DRG) Assignments

Outpatient Hospital Coding . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6,7Comprehensive Ambulatory Payment Classification (C-APCs)Medicare Hospital Outpatient Catheter Ablation C-Code Listing

For questions or for more information, please contact the Medtronic Cardiac Rhythm & Heart Failure Reimbursement Hotline at 1-866-877-4102.

The coding suggestions and coding guidelines in this guide do not replace seeking coding advice from the payer and/or your own coding staff. The ultimate responsibility for correct coding lies with the provider of services. Please contact your local payer for interpretation of the appropriate codes to use for specific procedures. Medtronic makes no guarantee that the use of this information will prevent differences of opinion or disputes with Medicare or other third-party payers as to the correct form of billing or the amount that will be paid to providers of service.

Where reimbursement is requested for the use of a product that may be inconsistent or not expressly specified in the FDA cleared or approved labeling (e.g., instructions for use, operator’s manual, or package insert), consult with your billing advisors or payers for advice on handling such billing issues. Some payers may have policies that make it inappropriate to submit claims for such items or related services.

DIAGNOSIS CODESICD-10-CM1 Diagnosis Codes that May Support Ablation ProceduresThe following is a list of diagnosis codes that may be associated with VT, SVT, and PVI ablation procedures . The list is for illustrative purposes only .

Refer to the Instructions for Use supplied with a product for indications, contraindications, side effects, warnings, and precautions.

ICD-10-CM1 Diagnosis Code ICD-10-CM1 Diagnosis Code Description

I47.0 Re-entry ventricular arrhythmia

I47.1 Supraventricular tachycardia (includes AVNRT)

I47.2 Ventricular tachycardia

I47.9 Paroxysmal tachycardia, unspecified

I48.0 Paroxysmal atrial fibrillation

I48.1 Persistent atrial fibrillation

I48.2 Chronic atrial fibrillation

I48.3 Typical atrial flutter (type I)

I48.4 Atypical atrial flutter (type (II)

I49.01 Ventricular fibrillation

I49.02 Ventricular flutter

I49.1 Atrial premature depolarization (premature atrial beats and contractions)

I49.2 Junctional premature depolarization

I49.3 Ventricular premature depolarization (premature ventricular contractions)

I49.40 Unspecified premature depolarization (unspecified premature beats)

I49.49 Other premature depolarization (includes ectopic beats)

I49.5 Sick sinus syndrome (tachycardia-bradycardia syndrome)

I49.8 Other specified cardiac arrhythmias

I49.9 Cardiac arrhythmia, unspecified

I48.91 Unspecified atrial fibrillation

I48.92 Unspecified atrial flutter

3 of 8 September 2018

COVERAGE FOR CATHETER ABLATION PROCEDURES Medicare:Medicare has not issued national or local coverage determinations for catheter ablation services. The Social Security Act allows coverage and payment for only those services that are considered to be medically reasonable and necessary.2 The medical necessity for services provided must be documented in the medical record.

Other Payers:We recommend that you contact the patient’s insurance company for guidance on what specific codes are required for catheter ablation procedures as part of your request for a prior authorization or a predetermination.

PHYSICIAN SERVICES CODINGSignificant changes were made to the CPT® codes for catheter ablation procedures for services performed on and after January 1, 2013. Both the catheter ablation and electrophysiological study (EPS) aspects of the procedure are reflected in these catheter ablation codes. In some instances, the catheter ablation and EPS procedures are no longer considered distinct procedures and therefore not reportable with separate codes.

Some of the CPT3 codes used to describe EP diagnostic and cardiac catheter ablation procedures, as well as mapping procedures, which may sometimes be concurrently performed at physician’s discretion, are listed below.

Catheter Ablation:

CPT3 Code CPT3 Code Description

2018 Medicare National Physician Rate

93650 Intracardiac catheter ablation of atrioventricular node function, atrioventricular conduction for creation of complete heart block, with or without temporary pacemaker placement

$619.19

93653 Comprehensive electrophysiologic evaluation including insertion and repositioning of multiple electrode catheters with induction or attempted induction of an arrhythmia with right atrial pacing and recording, right ventricular pacing and recording (when necessary) and His bundle recording (when necessary) with intracardiac catheter ablation of arrhythmogenic focus; 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 (Do not report 93653 in conjunction with 93600-3, 93610, 93612, 93618-20, 93642, 93654, 93656)

$875.87

93654 …with treatment of ventricular tachycardia or focus of ventricular ectopy including intracardiac electrophysiologic 3D mapping, when performed, and left ventricular pacing and recording, when performed (Do not report 93654 in conjunction with 93279-84, 93286-9, 93600-3, 93609-10, 93612-3, 93618-20, 93622, 93642, 93653, 93656)

$1,173.23

93656 Comprehensive electrophysiologic evaluation including transseptal catheterizations, insertion and repositioning of multiple electrode catheters with induction or attempted induction of an arrhythmia including left or right atrial pacing/recording when necessary, right ventricular pacing/recording when necessary and His bundle recording when necessary with intracardiac catheter ablation of atrial fibrillation by pulmonary vein isolation (Do not report 93656 in conjunction with 93279-84, 93286-9, 93462, 93600, 93602-3, 93610, 93612, 93618-21, 93653-4)

$1,176.47

The ablation procedure codes 93650, 93653, 93654 and 93656 are distinct primary procedure codes and may not be reported together.

Add-on codes +93655 and +93657 may be applicable when intracardiac catheter ablation of a discrete arrhythmia is performed after the treatment of the primary ablated mechanism.

+93655 Intracardiac catheter ablation of a discrete mechanism of arrhythmia which is distinct from the primary ablated mechanism, including repeat diagnostic maneuvers, to treat a spontaneous or induced arrhythmia (Use 93655 in conjunction with 93653-4, 93656)

$446.40

4 of 8 September 2018

CPT3 Code CPT3 Code Description

2018 Medicare National Physician Rate

+93657 Additional linear or focal intracardiac catheter ablation of the left or right atrium for treatment of atrial fibrillation remaining after completion of pulmonary vein isolation (Use 93657 in conjunction with 93656)

$446.04

+93462 Left heart catheterization by transseptal puncture through intact septum or by transapical puncture (Use 93462 in conjunction with 33477, 93452-3, 93458-93461, 93582, 93653-4) (Do not report 93462 in conjunction with 93656) (Do not report 93462 in conjunction with 0345T unless transapical puncture is performed)

$219.96

When reporting ablation therapy codes (93653 – 93657), comprehensive EP studies may not be separately reported.

Diagnostic Electrophysiologic Study (EPS):Coding information to be used when a physician performs a diagnostic electrophysiologic study (EPS) prior to a catheter ablation on a diffrent DOS.

CPT3 Code CPT3 Code Description

2018 Medicare National Physician Rate

93619 Comprehensive electrophysiologic evaluation with right atrial pacing and recording, right ventricular pacing and recording, His bundle recording, including insertion and repositioning of multiple electrode catheters, without induction or attempted induction of arrhythmia (Do not report 93619 in conjunction with 93600, 93602-3, 93610, 93612, 93618, 93620-2, 93653-7)

$409.32

93620 Comprehensive electrophysiologic evaluation including insertion and repositioning of multiple electrode catheters with induction or attempted induction of arrhythmia; with right atrial pacing and recording, right ventricular pacing and recording, His bundle recording (Do not report 93620 in conjunction with 93600, 93602-3, 93610, 93612, 93618-9, 93653-7)

$657.35

+93621 with left atrial pacing and recording from coronary sinus or left atrium (Use 93621 in conjunction with 93620, 93653-4) (Do not report 93621 in conjunction with 93656)

$122.76

+93622 with left ventricular pacing and recording (Use 93622 in conjunction with 93620, 93653, 93656) (Do not report 93622 in conjunction with 93654)

$180.36

+93623 Programmed stimulation and pacing after intravenous drug infusion (Use 93623 in conjunction with 93610, 93612, 93619-20, 93653-4, 93656)

$166.32

+93662 Intracardiac echocardiography during therapeutic/diagnostic intervention, including imaging supervision and interpretation (Use 93662 in conjunction with 92987, 93453, 93460-2, 93532, 93580-1, 93620-2, 93653-4, 93656 as appropriate) (Do not report 92961 in addition to 93662)

Carrier-priced

93624 Electrophysiologic follow-up study with pacing and recording to test effectiveness of therapy, including induction or attempted induction of arrhythmia

$261.00

Mapping is considered a distinct procedure performed in addition to a diagnostic EP study or ablation procedure and may be separately reported

+93609 Intraventricular and/or intra-atrial mapping of tachycardia site(s) with catheter manipulation to record from multiple sites to identify origin of tachycardia (Use 93609 in conjunction with 93620, 93653, 93656) (Do not report 93609 in conjunction with 93613, 93654)

$291.24

+93613 Intracardiac electrophysiologic 3-dimensional mapping (Use 93613 in conjunction with 93620, 93653, 93656) (Do not report 93613 in conjunction with 93609, 93654)

$337.68

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OUTPATIENT HOSPITAL CODINGComprehensive Ambulatory Payment Classifications (C-APCs):

CPT3 Code Brief Description

2018 Medicare National Hospital Outpatient Rate C-APC C-APC Description

93619Electrophysiology eval w/o arrhythmia

$5,314.32 5212 Level 2 Electrophysiologic Procedures93620Electrophysiology eval w/arrhythmia

93624 EP follow-up study

93650 AV node ablation

93653 SVT ablation and EP eval

$18,516.13 5213 Level 3 Electrophysiologic Procedures93654 VT ablation and EP eval

93656Ablation of AF by PVI with transseptal and EP evaluation

The following codes are not assigned to an APC as they are ancillary to the primary procedures. Medicare classifies the following codes with an “N” Status Indicator and does not separately reimburse hospitals for these procedures. Hospitals should report all applicable codes, including those for packaged services, according to correct coding principles.

+93462 Transseptal puncture (Use 93462 in conjunction with 33477, 93452-3, 93458-61, 93461, 93582-4) (Do not report 93642 in conjunction with 93656) (Do not report 93462 in conjunction with 0345T unless transapical puncture is performed)

+93609 Intraventricular and/or intra-atrial mapping (Use 93609 in conjunction with 93620, 93653, 93656) (Do not report 93609 in conjunction with 93613, 93654)

+93613 Intracardiac 3-dimensional mapping (Use 93613 in conjunction with 93620, 93653, 93656) (Do not report 93613 in conjunction with 93609, 93654)

+93621 Comprehensive EP evaluation; with left atrial pacing and recording from coronary sinus or left atrium (Use 93621 in conjunction with 93620, 93653-4) (Do not report 93621 in conjunction with 93656)

+93622 Comprehensive EP evaluation; with left ventricular pacing and recording (Use 93622 in conjunction with 93620, 93653, 93656) (Do not report 93622 in conjunction with 93654)

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INPATIENT HOSPITAL CODINGICD-10-PCS4 Procedure Codes for Percutaneous Ablation Procedures

ICD-10-PCS4 Procedure Code ICD-10-PCS4 Procedure Code Description4A023FZ Measurement of cardiac rhythm, percutaneous approach

02K83ZZ Map conduction mechanism, percutaneous approach

02583ZZ Destruction of conduction mechanism, percutaneous approach

Possible DRG Assignments (MS-DRG: Medicare Severity Diagnosis Related Group)

MS-DRG Brief MS-DRG Description

2018 Medicare National Inpatient Rate

273 Percutaneous intracardiac procedures w/MCC $21,569.37

274 Percutaneous intracardiac procedures w/o MCC $16,683.71

MCC: Major complication or comorbidity

September 2018

C1731 — Catheter, Electrophysiology, Diagnostic, Other than 3D Mapping (20 or More Electrodes)

Device Model Number

StableMapr™ 04401SM, 04402SM

C1733 — Catheter, Electrophysiology, Diagnostic/Ablation, Other than 3D or Vector Mapping, Other than Cool Tip

Device Model NumberRF Enhancr™ II 31744523, 31745523, 31745533, 39745533, 39746534

RF Contactr™ 70256034, 70257533

RF Conductr™ MC 0786022, 0786042, 0787533, 0787544, 07857544, 07856042, 07856044, 0786044

RF Marinr™ MC 075302, 075312, 075402, 075405

5F RF Marinr™ 076514, 076515, 076583, 076584, 076585, 076586

Freezor™ Cardiac CryoAblation Catheter

307F1, 307F3, 307F5

Freezor™ MAX Cardiac CryoAblation Catheter

239F3, 239F5

Freezor™ Xtra Cardiac CryoAblation Catheter

227F1, 227F3, 227F5

Arctic Front Advance™ Cardiac CryoAblation Catheter

2AF234, 2AF284

C1766 — Introducer/Sheath, Guiding, Intracardiac Electrophysiolgical, Steerable, Other than Peel-away

Device Model NumberFlexCath Advance™ Steerable Sheath 4FC12

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Medicare Hospital Outpatient Catheter Ablation C-Code ListingC1730 — Catheter, Electrophysiology, Diagnostic, Other than 3D Mapping (19 or Fewer Electrodes)

Device Model Number

Torqr™ CS Diagnostic Catheter

041565CS, 041590CS, 041865CS

Torqr™, Soloist™ Diagnostic Catheter 041002JM, 041002UM, 041005DM, 041005JM, 041005UM, 04130DS, 04122JM, 04122UM, 04125JM, 04125UM, 441016JF, 441016U, 44216J, 44216JF, 44216U, 44516J, 44516JF, 44516U

Marinr™ CS 043302M, 043325M, 043328M

Marinr™ 072302, 072322M, 072402

Achieve™ Mapping Catheter 990063-015, 990063-020

Achieve Advance™ Mapping Catheter 2ACH15, 2ACH20, 2ACH25

+93623 Programmed stimulation and pacing after intravenous drug infusion (Use 93623 in conjunction with 93610, 93612, 93619-20, 93653-4, 93656)

+93655 Additional ablation of discrete arrhythmia, SVT or VT (Use 93655 in conjunction with 93653-4, 93656)

+93657 Additional linear focal lesion for AF (Use 93657 in conjunction with 93656)

+93662 Intracardiac echocardiography (Use 93662 in conjunction with 92987, 93453, 93460-2, 93532, 93580-1, 93620-2, 93653-4, 93656 as appropriate) (Do not report 92961 in addition to 93662)

September 2018

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References1 International Classification of Diseases, Tenth Revision, Clinical Modification. http://www.cdc.gov/nchs/icd/icd10cm.htm. Accessed August 31, 2018.2 Social Security Act Section 1862 42 U.S.C. 1395y(a)(1)(A), is available at http://www.ssa.gov/OP_Home/ssact/title18/1862.htm.3 Current Procedural Terminology (CPT) is ©2015 American Medical Association. All Rights Reserved. No fee schedules, basic units, relative causes

or related listings are included in CPT. The AMA assumes no liability for the data contained herein. Applicable FARS/DFARS Restrictions Apply to Government Use. Fee schedules, relative value units, conversion factors and/or related components are not assigned by the AMA, are not part of CPT, and the AMA is not recommending their use. The AMA does not directly or indirectly practice medicine or dispense medical services. The AMA assumes no liability for the data contained or not contained herein.

4 International Classification of Diseases, Tenth Revision, Procedure Coding System. https://www.cms.gov/Medicare/Coding/ICD10/2016-ICD-10-PCS-and-GEMs.html. Accessed August 31, 2018.