Ask Dr. Z

Would you agree with coding 93656, 93657 or 93656, 93657x4 for procedure below:

Indication: Persistent atrial fibrillation despite three ablations. Under ultrasound guidance two sheaths were placed in the right and one in the left femoral vein. Patient subsequently heparinized. A phased array Accunav ultrasound catheter was advanced to the right atrium. Under direct ultrasound visualization, the interatrial septum was crossed anteriorly and inferiorly with a safe-sept wire through a BRK-1 needle through a SL-0 sheath. The LA was mapped with a pentaray. The common left vein was isolated. The RSPV was isolated. The RIPV was patent. The VOM was cannulated. 1.5 cc ETOH injected through a 1.5 mm balloon. The RIPV was reisolated. Linear ablation was performed with RF across the left atrial roof. Linear ablation was performed with RF across the left atrial floor. Focal posterior wall ablation was performed isolating the posterior wall. He was cardioverted to sinus rhythm. Exit block was confirmed posteriorly. Patient left EP lab in good condition.