How To Use CPT Code 93650

CPT 93650 describes the intracardiac catheter ablation of atrioventricular node function, atrioventricular conduction for creation of complete heart block, with or without temporary pacemaker placement. This article will cover the description, procedure, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information, similar codes and billing examples.

1. What is CPT Code 93650?

CPT 93650 can be used to describe a procedure in which the provider destroys the muscle fibers that conduct electrical impulses in the heart to treat an abnormal heart rhythm. This is done through the use of a catheter inserted through the groin, and may involve the placement of a temporary pacemaker to regulate the heartbeat.

2. Official Description

The official description of CPT code 93650 is: ‘Intracardiac catheter ablation of atrioventricular node function, atrioventricular conduction for creation of complete heart block, with or without temporary pacemaker placement.’

3. Procedure

1. The provider places a temporary pacemaker via a subclavian vein, if necessary.
2. One or two catheters are advanced through the femoral vein in the groin into the right heart.
3. The provider identifies the His bundle and manipulates the catheter to reach it.
4. A radiofrequency current is delivered through the catheter to ablate atrioventricular conduction.
5. Additional current may be delivered using a catheter from the femoral artery retrograde, through the aorta, across the aortic valve to approach the left side of the septum.
6. The catheters and all instruments are removed, and pressure is applied to the wounds.

4. Qualifying circumstances

This procedure is performed on patients with complete heart block, which is a blockage of the electrical signals in the heart that control the heartbeat. It is used to treat abnormal heart rhythms and may involve the placement of a temporary pacemaker. The procedure is typically performed by a provider who is experienced in intracardiac electrophysiological procedures.

5. When to use CPT code 93650

CPT code 93650 should be used when the provider performs intracardiac catheter ablation of atrioventricular node function, atrioventricular conduction for creation of complete heart block, with or without temporary pacemaker placement. It should not be used for other types of ablation procedures or for the placement of a permanent pacemaker.

6. Documentation requirements

To support a claim for CPT 93650, the provider must document the following information:

• Indication for the procedure, such as complete heart block
• Details of the procedure performed, including the use of a temporary pacemaker if applicable
• Specific catheters used and their placement
• Delivery of radiofrequency current and any additional current delivered
• Removal of catheters and instruments
• Application of pressure to the wounds

7. Billing guidelines

When billing for CPT 93650, ensure that the procedure meets the criteria described in the official description. Do not report temporary pacemaker placement separately. If a permanent pacemaker is placed during the same session, it may be reported separately. It is important to review the specific documentation requirements and guidelines provided by the payer to ensure accurate billing and reimbursement.

8. Historical information

CPT 93650 was added to the Current Procedural Terminology system on January 1, 1990. There have been no updates to the code since its addition.

9. Examples

1. A provider performs intracardiac catheter ablation of atrioventricular node function, atrioventricular conduction for creation of complete heart block in a patient with complete heart block.
2. During the procedure, the provider uses a catheter inserted through the groin to deliver a radiofrequency current to ablate atrioventricular conduction.
3. No temporary pacemaker placement is necessary in this case.
4. The catheters and all instruments are removed, and pressure is applied to the wounds.
5. The provider documents the details of the procedure and the patient’s response to the treatment.