Q & A with Dr. Z: Atrial Flut­ter

by David Zielske, MD, CIRCC, COC, CCVTC, CCC, CCS, RCC

Patient has AF and atrial flut­ter. After completion of success­ful PVI, the physician performs a typical atrial flutter ablation. Three-dimensional mapping and conventional catheter mapping were performed using this abla­tion catheter and the left atrial coronary sinus decapolar cath­eter. Multiple radiofrequency lesions were administered, re­sulting in gradual slowing of the atrial flutter with eventual termi­nation. The ablation catheter was then placed in the lower lateral right atrial wall, and pacing was performed from the coronary si­nus catheter from coronary sinus. Conduction times across the ca­val tricuspid isthmus were noted to be [135] ms in both directions confirming a bidirectional block across the isthmus.

We were going to bill 93656 for the PVI and 93655 for the atrial flutter ablation, but the physician is thinking we should bill an additional 93655 for the CTI. Would you please review and see if we should add the additional code?

We only see one mechanism, which is typical a-flutter ablation here, so you would only report 93655 once.


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About the Author

David Zielske is founder and President of ZHealth Publishing and primary author and editor of ZHealth publications. Dr. Z practiced as an interventional radiologist and has over twenty years experience as a coding reviewer and coding expert. He is Board Certified in Radiology and has functioned as an independent interventional radiology, vascular surgery, and cardiovascular coding consultant to a variety of physician groups and hospital providers across the country. He also served as an instructor for over 200 coding seminars.

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