Ask Dr. Z

We see the following in a physician's dictation, and we aren't sure about using the additional ablation codes. We thought code 93657 was used if you assess after the PV ablation and find additional focus, but this reads as if he does the roof line after the PV and doesn't mention additional focus. Also we have been told the cavotricuspid isthmus ablation is A-flutter ablation... does it need to be worded differently?

Using the LassoNav and ablation catheters, a 3-dimensional map of the left atrium was created using the FAM technique. The anatomy as defined by this technique closely correlated with that seen on the CTA and ultrasound images. Particular attention was paid to the regions of the pulmonary vein antral regions and the ridge separating the left atrial appendage from the left pulmonary veins. RF lesions were then placed in a contiguous manner to isolate the pulmonary vein antral regions, across the left atrial roof, and inferiorly between the inferior pulmonary veins. (Does this meet criteria for code 93657?) RF application was continued until local electrogram abatement was seen. The catheter was then moved to the next target site. If the impedance either increased or decreased precipitously, or if the temperature measured in the sophageal temperature sensor increased by >0.5 degrees Celsius, RF application was terminated, and the catheter was repositioned. Cavotricuspid isthmus ablation was performed and bidirectional block was confirmed. (Does this meet criteria for code 93655?) After an appropriate waiting period, isoproterenol infusion was begun at a dose of 20mcg/min. The pulmonary veins were again interrogated with the circular catheter. There was no evidence of acute reconnection; no atrial fibrillation was induced; no significant atrial ectopy was present.