Ask Dr. Z

Persistant atrial flutter Is this coded 93656 or 93653?

"Procedures performed: 

Confirmed Durable Pulmonary vein isolation from prior ablation

Lateral mitral isthmus line, anterior to LAA

Posterior scar and inferior posterior wall ablation

Posterior septal scar ablation

Atrial pacing was performed to reinduce atrial flutter. Initial pacing from the distal CS down to 240ms induced atrial fibrillation. Reentry formation in AF were seen along the posterior septum. AF terminated spontaneously. REpeat pacing (atrial double extra stimuli from the lateral LA appendage successfully reinduced the clinical flutter. Activation mapping confirmed a left atrial flutter circuit around the LAA, through the scar at the anterior base of the LAA and through the coumadin ridge. RF ablation lesions were performed at this site, with a line created from superior-anterior base of LAA, adjacent to the LSPV to the lateral wall scar with termination of the flutter. Pacing from HRA identified persistent conduction and further ablation lesions were applied until pacing identified bidirectional conduction block across the anterior."