Ask Dr. Z

How to code RFA of LV basal antero-septal segment for purpose of reducing myocardial thickness using saline vs. alcohol. AV nodal ablation was also performed same setting. What would be the best code to use 93583 vs. unlisted? If unlisted, would the comparable code be 93583, 93653, 93654?

"RADIOFREQUENCY ABLATION OF THE BASAL ANTERO-SEPTAL SEGMENT OF THE LV. Radiofrequency ablation was performed guided by intracardiac echo and fluoro. Extensive ablation was carried out utilizing a power of 40 Watts, with contact force of 10-30 grams, half normal saline as an irrigant, and each lesion 60-90 seconds application. Steam pops were frequently noted, as expected.  Half normal saline was used to create larger and deeper myocardial scar. Procedure was long and complicated (5 hrs), but the patient tolerated it well."