How To Use CPT Code 93656

CPT 93656 is a comprehensive electrophysiologic evaluation code that includes transseptal catheterizations, insertion and repositioning of multiple electrode catheters, intracardiac catheter ablation of atrial fibrillation by pulmonary vein isolation, and more. This article will cover topics such as the description, procedure, qualifying circumstances, when to use the code, documentation requirements, billing guidelines, historical information, similar codes, and examples of CPT 93656 procedures.

1. What is CPT 93656?

CPT 93656 is a code used to represent a comprehensive electrophysiologic evaluation that involves various diagnostic and treatment procedures related to atrial fibrillation. This code is used by healthcare providers to bill for the services provided during the evaluation and treatment of patients with atrial fibrillation.

2. 93656 CPT code description

The official description of CPT code 93656 is: 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.

3. Procedure

1. The patient is prepped and anesthetized.
2. Sheaths for vascular access are placed in the groin or neck.
3. Electrode catheters are inserted through the sheaths and guided to the heart using imaging guidance.
4. Electrodes are placed in desired areas to check the heart’s electrical system, repositioning as needed.
5. Transseptal catheterization is performed to access necessary sites in the heart.
6. Arrhythmia is induced or attempted to be induced by introducing electrical impulses.
7. Intracardiac electrophysiologic 3D mapping is performed to depict the site of arrhythmia’s origin or path through the heart.
8. Intracardiac echocardiography (ICE) is performed to evaluate cardiac structures, including imaging supervision and interpretation.
9. Pacing and recording are performed, including left or right atrial pacing/recording, right ventricular pacing/recording, and His bundle recording, when necessary.
10. Ablation is used to treat atrial fibrillation by pulmonary vein isolation (PVI), creating scarring around the pulmonary veins’ connection to the left atrium to block irregular impulses.
11. All equipment is removed, and bleeding at the access site is stopped.

4. Qualifying circumstances

Patients eligible to receive CPT code 93656 services are those diagnosed with atrial fibrillation who require a comprehensive electrophysiologic evaluation and treatment. This includes patients with symptomatic atrial fibrillation, those who have not responded to medication or other treatments, and those at risk for complications such as stroke or heart failure.

5. When to use CPT code 93656

It is appropriate to bill the 93656 CPT code when a comprehensive electrophysiologic evaluation and treatment, including pulmonary vein isolation, are performed on a patient with atrial fibrillation. This code should be used when all the components described in the official code description are performed during the procedure.

6. Documentation requirements

To support a claim for CPT 93656, the following information should be documented in the patient’s medical record:

• Patient’s diagnosis of atrial fibrillation
• Indications for the comprehensive electrophysiologic evaluation and treatment
• Details of the procedure, including all components performed as described in the code
• Results of the evaluation, including findings from intracardiac electrophysiologic 3D mapping and intracardiac echocardiography
• Outcome of the ablation treatment, including the success of pulmonary vein isolation
• Any complications or adverse events that occurred during the procedure

7. Billing guidelines

When billing for CPT code 93656, it is essential to follow the guidelines and rules set forth by the American Medical Association (AMA) and the Centers for Medicare & Medicaid Services (CMS). This code represents a comprehensive study with treatment, so individual services included should not be reported additionally. Review guidelines carefully to determine which codes may be reported in addition to this code.

8. Historical information

CPT 93656 was added to the Current Procedural Terminology system on January 1, 2013. There have been updates to the code description since its addition, with the most recent change occurring on January 1, 2022.

9. Similar codes to CPT 93656

Five similar codes to CPT 93656 and how they differentiate are:

• CPT 93653: Focuses on intracardiac catheter ablation of supraventricular tachycardia, not specifically atrial fibrillation.
• CPT 93654: Involves intracardiac catheter ablation of ventricular tachycardia, targeting a different type of arrhythmia.
• CPT 93655: Addresses additional linear or focal intracardiac catheter ablation for atrial fibrillation, performed in conjunction with pulmonary vein isolation.
• CPT 93650: Represents intracardiac catheter ablation of the atrioventricular junction, a different treatment approach for arrhythmias.
• CPT 93660: Focuses on tilt table evaluation for syncope, a diagnostic procedure not involving ablation.

10. Examples

Here are 10 detailed examples of CPT code 93656 procedures:

1. A patient with symptomatic paroxysmal atrial fibrillation undergoes a comprehensive electrophysiologic evaluation and pulmonary vein isolation ablation.
2. A patient with persistent atrial fibrillation who has failed antiarrhythmic drug therapy undergoes a comprehensive electrophysiologic evaluation and pulmonary vein isolation ablation.
3. A patient with atrial fibrillation and a history of stroke undergoes a comprehensive electrophysiologic evaluation and pulmonary vein isolation ablation as part of a risk reduction strategy.
4. A patient with atrial fibrillation and heart failure undergoes a comprehensive electrophysiologic evaluation and pulmonary vein isolation ablation to improve cardiac function.
5. A patient with long-standing persistent atrial fibrillation undergoes a comprehensive electrophysiologic evaluation and pulmonary vein isolation ablation as a last resort treatment option.
6. A patient with atrial fibrillation and recurrent syncope undergoes a comprehensive electrophysiologic evaluation and pulmonary vein isolation ablation to address the underlying cause of syncope.
7. A patient with atrial fibrillation and a high risk of thromboembolic events undergoes a comprehensive electrophysiologic evaluation and pulmonary vein isolation ablation to reduce the risk of future events.
8. A patient with atrial fibrillation who is not a candidate for anticoagulation therapy undergoes a comprehensive electrophysiologic evaluation and pulmonary vein isolation ablation as an alternative treatment approach.
9. A patient with atrial fibrillation and recurrent palpitations undergoes a comprehensive electrophysiologic evaluation and pulmonary vein isolation ablation to alleviate symptoms and improve quality of life.
10. A patient with atrial fibrillation and a history of cardioversion failure undergoes a comprehensive electrophysiologic evaluation and pulmonary vein isolation ablation to achieve rhythm control.