Ask Dr. Z

"Patient comes in for pulmonary vein ablation but has typical Aflutter instead of atrial fib. This confirmed the diagnosis of mitral isthmus dependent atrial flutter. In order to create adequate flutter ablation lines, I elected to isolate the left pulmonary vein. It was a large common vein. Ablation was then performed, connecting the mitral valve annulus back to the common pulmonary vein. With ablation, there is change in tachycardia cycle length. Remapping of the atrial flutter showed that this was now a different atrial flutter circuit, new roof dependent atrial flutter. This was confirmed with entrainment mapping. Linear ablation was then performed around the right pulmonary veins. Esophageal temperature was monitored throughout the ablation procedure. Entrance and exit block were confirmed in all pulmonary veins following ablation."

Would you report code 93656 or 93653 with add-on codes 93462 and 93621?