Ask Dr. Z

How would we code this repeat ablation following PVI? Would it make a difference if the attempts at isolating the RAA had been successful?

"A patient with persistent atrial fibrillation and atrial flutter after previous PVI returns to the OR for follow-up ablation. Mapping confirmed isolation of the left posterior atrial wall consistent with prior ablation. Due to recordings of atrial flutter, further applications of RF energy were applied anteriorly and medial to the left atrial appendage from the mitral valve annulus to the roof of the left atrium. Further applications of RF energy were applied anteriorly from the carina of the right pulmonary vein to the left atrial appendage. Due to recurrence of atrial fibrillation despite PVI, a decision was made to map the right atrium. Attempts at isolating the right atrial appendage were unsuccessful. A decision was made to terminate the procedure at that point."