Notification



Notification Issue Date:



Medical Policy Bulletin


Title:Catheter Ablation of Cardiac Arrhythmias

Policy #:11.02.06l

This policy is applicable to the Company’s commercial products only. Policies that are applicable to the Company’s Medicare Advantage products are accessible via a separate Medicare Advantage policy database.


The Company makes decisions on coverage based on Policy Bulletins, benefit plan documents, and the member’s medical history and condition. Benefits may vary based on contract, and individual member benefits must be verified. The Company determines medical necessity only if the benefit exists and no contract exclusions are applicable.

When services can be administered in various settings, the Company reserves the right to reimburse only those services that are furnished in the most appropriate and cost-effective setting that is appropriate to the member’s medical needs and condition. This decision is based on the member’s current medical condition and any required monitoring or additional services that may coincide with the delivery of this service.

This Medical Policy Bulletin document describes the status of medical technology at the time the document was developed. Since that time, new technology may have emerged or new medical literature may have been published. This Medical Policy Bulletin will be reviewed regularly and be updated as scientific and medical literature becomes available. For more information on how Medical Policy Bulletins are developed, go to the About This Site section of this Medical Policy Web site.



Policy

Coverage is subject to the terms, conditions, and limitations of the member's contract.

SUPRAVENTRICULAR ARRHYTHMIAS

Catheter ablation of cardiac arrhythmias is considered medically necessary and, therefore, covered for individuals who have any of the following symptomatic supraventricular arrhythmias:
  • Supraventricular tachycardia
  • Accessory bypass tract arrhythmia (Wolff-Parkinson-White syndrome)
  • Atrial tachyarrhythmia (when ablation is intended to modify the atrioventricular junction to obtain ventricular rate control)
  • Sustained atrioventricular nodal re-entrant tachycardia
  • Atrial tachycardia or atrial flutter

Catheter ablation is considered medically necessary and, therefore, covered for any of the following:
  • Individuals with recurrent symptomatic paroxysmal atrial fibrillation (greater than one episode, with four or less episodes in the previous six months) in whom a rhythm-control strategy is desired, as an initial treatment
  • Individuals with symptomatic or persistent atrial fibrillation, who have failed at least one antiarrhythmic medication, as an alternative to continued medical management
  • Individuals with class II or III congestive heart failure and symptomatic atrial fibrillation in whom heart rate is poorly controlled by standard medications, as an alternative to atrial ventricular nodal ablation and pacemaker insertion

Repeat catheter ablation may be considered medically necessary in individuals with recurrence of atrial fibrillation and/or development of atrial flutter following the initial procedure.

VENTRICULAR ARRHYTHMIAS

Catheter ablation is considered medically necessary and, therefore, covered for individuals with ventricular arrhythmias who meet any the following conditions:
  • Bundle branch re-entrant
  • Interfascicular ventricular tachycardia
  • Sustained monomorphic ventricular tachycardia
  • Ventricular dysfunction presumed to be caused by frequent premature ventricular contractions (PVC)
  • Non-sustained ventricular tachycardia (NSVT)
  • Ventricular tachycardia

AND either of the following conditions:
  • Structural heart disease (i.e., ischemic or idiopathic cardiomyopathy)
  • Monomorphic ventricular tachycardia without structural heart disease

In addition, at least one of the following criteria must also be met:
  • Pharmacologic management of the arrhythmia is not tolerated by the individual.
  • The arrhythmia is drug-resistant (continued arrhythmia that has failed at least one trial of an antiarrhythmic drug at a therapeutic dose).
  • Pharmacologic management of the arrhythmia is contraindicated in the individual.
  • The procedure is being used as first-line therapy in a premenopausal woman with arrhythmia who is planning pregnancy.

Catheter ablation of cardiac arrhythmias is considered medically necessary and, therefore, covered for individuals who have chronic, recurrent monomorphic ventricular tachycardia that is refractory to antiarrhythmic therapy with an implantable cardioverter-defibrillator and antiarrhythmic medication, and for which an identifiable arrhythmogenic focus can be identified.

Catheter ablation of cardiac arrhythmias is considered medically necessary and, therefore, covered for individuals who have polymorphic ventricular tachycardia electrical "storm" also known as incessant ventricular tachycardia (i.e., at least three episodes of sustained ventricular tachycardia in a 24-hour period) that is not controlled with an antiarrhythmic drug at a therapeutic dose.

All other uses for catheter ablation of cardiac arrhythmias are considered not medically necessary and, therefore, not covered because the available published peer-reviewed literature does not support their use in the treatment of illness or injury.

REQUIRED DOCUMENTATION

The individual's medical record must reflect the medical necessity for the care provided. These medical records may include, but are not limited to: records from the professional provider's office, hospital, nursing home, home health agencies, therapies, and test reports.

The Company may conduct reviews and audits of services to our members, regardless of the participation status of the provider. All documentation is to be available to the Company upon request. Failure to produce the requested information may result in a denial for the service.
Guidelines

ATRIAL FIBRILLATION SUB-TYPES
  • Paroxysmal (episodes that last less than seven days and are self-terminating)
  • Persistent (episodes that last for greater than seven days and can be terminated pharmacologically or by electrical cardioversion)
  • Permanent

NEW YORK HEART ASSOCIATION CLASSIFICATION OF HEART FAILURE

ClassPatient Symptoms
Class I (Mild)No limitation of physical activity. Ordinary physical activity does not cause undue fatigue, palpitation, or dyspnea (shortness of breath).
Class II (Mild)Slight limitation of physical activity. Comfortable at rest, but ordinary physical activity results in fatigue, palpitation, or dyspnea.
Class III (Moderate)Marked limitation of physical activity. Comfortable at rest, but less than ordinary activity causes fatigue, palpitation, or dyspnea.
Class IV (Severe)Unable to carry out any physical activity without discomfort. Symptoms of cardiac insufficiency at rest. If any physical activity is undertaken, discomfort is increased.

BENEFIT APPLICATION

Subject to the terms and conditions of the applicable benefit contract, catheter ablation of cardiac arrhythmias and transcatheter radiofrequency ablation of the pulmonary veins is covered under the medical benefits of the Company’s products when the medical necessity criteria listed in this medical policy are met.

US FOOD AND DRUG ADMINISTRATION (FDA) STATUS

There are numerous devices approved by the FDA for catheter ablation of cardiac arrhythmias.

Description

Catheter ablation of cardiac arrhythmias is a nonsurgical procedure that is used to correct an abnormality in the heart's electrical conduction system. Alterations or defects in the conduction system can lead to an abnormal rhythm (arrhythmia) that causes the heart to beat too fast or too slow, or to pump in an ineffective rhythmic pattern. Abnormal pumping of the heart causes the body's vital organs to receive less than optimal blood flow, which often has serious consequences.

Catheter ablation of cardiac arrhythmias is performed in an electrophysiology or cardiac catheterization laboratory. During the procedure, a catheter is threaded through a blood vessel and directed into the heart. Electrophysiology studies are performed to determine the location of the arrhythmia. Once the location is identified, the catheter is moved into position, and the tissue at the site is ablated (destroyed) by either radiofrequency energy (radiofrequency ablation) or intense cold (cryoablation). In some cases, multiple catheters may be used. This procedure is performed on individuals who prove resistant or intolerant to pharmacologic care or other means of treatment. The effect of ablation is usually permanent.

Atrial fibrillation is a common cardiac arrhythmia that may be triggered by discrete foci located within the pulmonary veins. Unlike other supraventricular arrhythmias, the situation is more complex for atrial fibrillation because there is not a single arrhythmogenic focus. In the late 1990s, it was recognized that atrial fibrillation most frequently arose from an abnormal focus at or near the junction of the pulmonary veins and the left atrium, thus leading to the feasibility of more focused, percutaneous ablation techniques.

Catheter ablation of the pulmonary veins, also known as pulmonary vein isolation, targets the trigger of atrial fibrillation within the pulmonary veins and electrically isolates the foci to eliminate the atrial fibrillation. Several approaches have emerged for pulmonary vein isolation, including segmental ostial ablation guided by pulmonary vein potential (electrical approach) and circumferential pulmonary vein ablation (anatomical approach). Pulmonary vein isolation is typically performed in an electrophysiology laboratory, using either radiofrequency or cryoablation technology.

Repeat pulmonary vein isolations following initial pulmonary vein isolation are commonly performed if atrial fibrillation recurs or if atrial flutter develops post-procedure. The need for repeat procedures may, in part, depend on clinical characteristics of the individual (age, persistent vs. paroxysmal atrial fibrillation, atrial dilatation, etc.) and the type of initial ablation performed. Repeat procedures are generally more limited than the initial procedure. For example, in cases where electrical reconnections occur as a result of incomplete ablation lines, a ”touch up” procedure is done to correct gaps in the original ablation. In other cases where atrial flutter develops following ablation, a ”flutter ablation” is performed, which is more limited than the original atrial fibrillation ablation procedure. In most of the published studies, success rates were based on having as many as three separate procedures, although these repeat procedures may be more limited than the initial procedure.
References


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Liu XH, Chen CF, Gao XF, et al. Safety and efficacy of different catheter ablations for atrial fibrillation: a systematic review and meta-analysis. Pacing Clin Electrophysiol. 2016;39(8):883-899.

Luik A, Merkel M, Hoeren D, et al. Rationale and design of the FreezeAF: a randomized controlled noninferiority trial comparing isolation of the pulmonary veins with the cryoballoon catheter versus open irrigated radiofrequency ablation in patients with paroxysmal atrial fibrillation. Am Heart J. 2010;159(4):555-60.e1.

Mallidi J, Nadkarni GN, Berger RD, et al. Meta-analysis of catheter ablation as an adjunct to medical therapy for treatment of ventricular tachycardia in patients with structural heart disease. Heart Rhythm. 2011;8(4):503-510.

Malmborg H, Lonnerholm S, Blomstrom P, et al. Ablation of atrial fibrillation with cryoballoon or dutycycled radiofrequency pulmonary vein ablation catheter: a randomized controlled study comparing the clinical outcome and safety; the AF-COR study. Europace. 2013; 15(11):1567-1573.

Mont L, Bisbal F, Hernandez-Madrid A, et al. Catheter ablation vs. antiarrhythmic drug treatment of persistent atrial fibrillation: a multicentre, randomized, controlled trial (SARA study). Eur Heart J. 2014;35(8):501-507.

Morillo CA, Verma A, Connolly SJ, et al. Radiofrequency ablation vs antiarrhythmic drugs as firstline treatment of paroxysmal atrial fibrillation (RAAFT-2): a randomized trial. JAMA. 19 2014;311(7):692-700.

Morady F. Catheter ablation of supraventricular arrhythmias: state of the art. Pacing Clin Electrophysiol. 2004; 27(1):125-142.

Mork TJ, Kristensen J, Gerdes JC, et al. Catheter ablation for ventricular tachycardia in ischaemic heart disease; Acute success and long-term outcome. Scand Cardiovasc J. 2014; 48(1):27-34.

Mussigbrodt A, Dinov B, Bertagnoli L, et al. Precordial QRS amplitude ratio predicts long-term outcome after catheter ablation of electrical storm due to ventricular tachycardias in patients with arrhythmogenic right ventricular cardiomyopathy. J Electrocardiol. 2015;48(1):86-92.

Nagashima K, Choi EK, Tedrow UB, et al. Correlates and prognosis of early recurrence after catheter ablation for ventricular tachycardia due to structural heart disease. Circ Arrhythm Electrophysiol. 2014;7(5):883-888.

Nair GM, Nery PB, Diwakaramenon S, et al. A systematic review of randomized trials comparing radiofrequency ablation with antiarrhythmic medications in patients with atrialfibrillation. J Cardiovasc Electrophysiol. 2009;20(2):138-44.

Nayyar S, Ganesan AN, Brooks AG, et al. Venturing into ventricular arrhythmia storm: a systematic review and meta-analysis. Eur Heart J. 2013;34(8):560-571.

Neumann T, Vogt J, Schumacher B, et al. Circumferential pulmonary vein isolation with the cryoballoon technique results from a prospective 3-center study. J Am Coll Cardiol. 2008;52(4):273-278.

Neumann T, Wojcik M, Berkowitsch A, et al. Cryoballoon ablation of paroxysmal atrial fibrillation: 5-year outcome after single procedure and predictors of success. Europace. 2013; 15(8):1143-1149.

Nielsen JC, Johannessen A, Raatikainen P, et al. Long-term efficacy of catheter ablation as first-line therapy for paroxysmal atrial fibrillation: 5-year outcome in a randomised clinical trial. Heart. 2017;103(5):368-376.

Noheria A, Kumar A, Wylie JV Jr, Josephson ME. Catheter ablation vs. antiarrhythmic drug therapy for atrial fibrillation: a systematic review. Arch Intern Med. 2008;168(6):581-586.

Nyong J, Amit G, Adler AJ, et al. Efficacy and safety of ablation for people with non-paroxysmal atrial fibrillation. Cochrane Database Syst Rev. Nov 22 2016;11:CD012088.

Oral H, Pappone C, Chugh A, et al. Circumferential pulmonary-vein ablation for chronic atrial fibrillation. N Engl J Med. 2006;354(9):934-941.

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Pappone C, Augello G, Sala S, et al. A randomized trial of circumferential pulmonary vein ablation versus antiarrhythmic drug therapy in paroxysmal atrial fibrillation: the APAF Study. J Am Coll Cardiol. 2006;48(11):2340-2347.

Passman R. Catheter ablation to prevent recurrent atrial fibrillation: Clinical applications. [UpToDate]. 07/06/2016. Available at:
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Paylos JM, Hoyt RH, Ferrero C, et al. Complete pulmonary vein isolation using balloon cryoablation in patients with paroxysmal atrial fibrillation. Rev Esp Cardiol. 2009;62(11):1326-1331.

Pokushalov E, Romanov A, De Melis M, et al. Progression of atrial fibrillation after a failed initial ablation procedure in patients with paroxysmal atrial fibrillation: a randomized comparison of drug therapy versus reablation. Circ Arrhythm Electrophysiol. 2013; 6(4):754-760.

Priori SG, Blomstrom-Lundqvist C, Mazzanti A, et al. 2015 ESC Guidelines for the management of patients with ventricular arrhythmias and the prevention of sudden cardiac Death. The Task Force for the Management of Patients with Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death of the European Society of Cardiology]. G Ital Cardiol (Rome). 2016;17(2):108-170.

Providencia R, Lambiase PD, Srinivasan N, et al. Is there still a role for complex fractionated atrial electrogram ablation in addition to pulmonary vein isolation in patients with paroxysmal and persistent atrial fibrillation. Metaanalysis
of 1415 patients. Circ Arrhythm Electrophysiol.2015;8(5):1017-1029.

Pytkowski M, Maciag A, Jankowska A, et al. Quality of life improvement after radiofrequency catheter ablation of outflow tract ventricular arrhythmias in patients with structurally normal heart. Acta Cardiol. 2012;67(2):153-159.

Raymond JM, Sacher F, Winslow R, et al. Catheter ablation for scar-related ventricular tachycardias. Curr Probl Cardiol. 2009;34(5):225-270.

Reddy VY, Dukkipati SR, Neuzil P, et al. Randomized, controlled trial of the safety and effectiveness of a contact force-sensing irrigated catheter for ablation of paroxysmal atrial fibrillation: results of the TactiCath Contact Force Ablation Catheter Study for Atrial Fibrillation (TOCCASTAR) Study. Circulation. 2015;132(10):907-915.

Reddy VY, Reynolds MR, Neuzil P, et al. Prophylactic catheter ablation for the prevention of defibrillator therapy. N Engl J Med. 2007;357(26):2657-2665.

Rodriguez-Entem FJ, Exposito V, Gonzalez-Enriquez S, et al. Cryoablation versus radiofrequency ablation for the treatment of atrioventricular nodal reentrant tachycardia: results of a prospective randomized study. J Interv Card Electrophysiol. 2013;36(1):41-45; discussion 45.

Rodriguez LM, Smeets JL, Timmermans C, et al. Predictors for successful ablation of right- and left-sided idiopathic ventricular tachycardia. Am J Cardiol. 1997;79(3):309-314.

Rubin E, Schwartz S. Worldwide experience with the Arctic Front cardiac CryoAblation System for treatment of atrial fibrillation (Abstract). Cryobiology. 2013;66(3):353.

Santangeli P, Muser D, Maeda S, et al. Comparative effectiveness of antiarrhythmic drugs and catheter ablation for the prevention of recurrent ventricular tachycardia in patients with implantable cardioverter-defibrillators: A systematic review and meta-analysis of randomized controlled trials. Heart Rhythm.2016;13(7):1552-1559.

Sapp JL, Wells GA, Parkash R, et al. Ventricular tachycardia ablation versus escalation of antiarrhythmic drugs. N Engl J Med. 2016;375(2):111-121.

Sawhney N, Anousheh R, Chen WC, et al. Five-year outcomes after segmental pulmonary vein isolation for paroxysmal atrial fibrillation. Am J Cardiol. 2009;104(3):366-372.

Schmidt M, Dorwarth U, Andresen D, et al. Cryoballoon versus RF Ablation in Paroxysmal Atrial Fibrillation: Results from the German Ablation Registry. J Cardiovasc Electrophysiol. 2014;25(1):1-7.

Schmidt M, Dorwarth U, Andresen D, et al. German ablation registry: Cryoballoon vs radiofrequency ablation in paroxysmal atrial fibrillation-One-year outcome data. Heart Rhythm. 2016;13(4):836-844.

Scott PA, Silberbauer J, Murgatroyd FD. The impact of adjunctive complex fractionated atrial electrogram ablation and linear lesions on outcomes in persistent atrial fibrillation: a meta-analysis. Europace. 2016;18(3):359-367.

Shah RU, Freeman JV, Shilane D, et al. Procedural complications, rehospitalizations, and repeat procedures after catheter ablation for atrial fibrillation. J Am Coll Cardiol. 2012;59(2):143-149.

Shemin RJ, Cox JL, Gillinov AM, et al. Guidelines for reporting data and outcomes for the surgical treatment of atrial fibrillation. Ann Thorac Surg. 2007;83(3):1225-1230.

Snow V, Weiss KB, LeFevre M, et al. Management of newly detected atrial fibrillation: a clinical practice guideline from the American Academy of Family Physicians and the American College of Physicians. Ann Intern Med. 2003;139(12):1009-1017.

Stabile G, Bertaglia E, Senatore G, et al. Catheter ablation treatment in patients with drug-refractory atrial fibrillation: a prospective, multi-centre, randomized, controlled study (Catheter Ablation for the Cure of Atrial Fibrillation Study). Eur Heart J. 2006;27(2):216-221.

Squara F, Zhao A, Marijon E, et al. Comparison between radiofrequency with contact force-sensing and secondgeneration cryoballoon for paroxysmal atrial fibrillation catheter ablation: a multicentre European evaluation. Europace. 2015;17(5):718-724.

Stevenson WG, Wilber DJ, Natale A, et al. Irrigated radiofrequency catheter ablation guided by electroanatomic mapping for recurrent ventricular tachycardia after myocardial infarction. The Multicenter Thermocool Ventricular Tachycardia Ablation Trial. Circulation. 2008;118(25):2773-2782.

Santangeli P, Muser D, Zado ES, et al. Acute hemodynamic decompensation during catheter ablation of scar-related VT: incidence, predictors and impact on mortality. Circ Arrhythm Electrophysiol. 2015;8(1):68-75.

Takigawa M, Takahashi A, Kuwahara T, et al. Long-term follow-up after catheter ablation of paroxysmal atrial fibrillation: the incidence of recurrence and progression of atrial fibrillation. Circ Arrhythm Electrophysiol. 2014;7(2):267-273.

Tanner H, Hindricks G, Volkmer M, et al. Catheter ablation of recurrent scar-related ventricular tachycardia using electroanatomic mapping and irrigated ablation technology: results of the prospective multicenter Euro-VT study. J Cardiovasc Electrophysiol. 2010;21(1):47-53.

Teunissen C, Kassenberg W, van der Heijden JF, et al. Five-year efficacy of pulmonary vein antrum isolation as a primary ablation strategy for atrial fibrillation: a single-centre cohort study. Europace. 2016;18(9):1335-1342.

Theis C, Konrad T, Mollnau H, et al. Arrhythmia termination versus elimination of dormant pulmonary vein conduction as a procedural end point of catheter ablation for paroxysmal atrial fibrillation: a prospective randomized trial. Circ Arrhythm Electrophysiol. 2015;8(5):1080-1087.

Tracy CM, Akhtar M, Dimarco JP, et al. American College of Cardiology/American Heart Association 2006 update of the clinical competence statement on invasive electrophysiology studies, catheter ablation, and cardioversion: a report of the American College of Cardiology/American Heart Association/ American College of Physicians Task Force on clinical competence and training. J Am Coll Cardiol.2006;48(7):1503-1517.

Tzou WS, Marchlinski FE, Zado ES, et al. Long-term outcome after successful catheter ablation of atrial fibrillation. Circ Arrhythm Electrophysio. 2010;3(3):237-242.

US Food and Drug Administration (FDA). Center for Devices and Radiological Health. Arctic Front CryoCatheter System. Premarket approval (PMA) database. [FDA Web site]. 12/17/2010. Available at: http://www.accessdata.fda.gov/cdrh_docs/pdf10/P100010a.pdf. Accessed January 03, 2018.

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Verma A, Jiang CY, Betts TR, et al. Approaches to catheter ablation for persistent atrial fibrillation. N Engl J Med.2015;372(19):1812-1822.

Vogt J, Heintze J, Gutleben KJ, et al. Long-term outcomes after cryoballoon pulmonary vein isolation: results from a prospective study in 605 patients. J Am Coll Cardiol. 2013;61(16):1707-1712.

Waldo AL, Wilber DJ, Marchlinski FE, et al. Safety of the open-irrigated ablation catheter for radiofrequency ablation: safety analysis from six clinical studies. Pacing and clinical electrophysiology. PACE. 2012;35(9):1081-1089.

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Wazni OM, Marrouche NF, Martin DO, et al. Radiofrequency ablation vs antiarrhythmic drugs as first-line treatment for symptomatic atrial fibrillation: a randomized trial. JAMA. 2005;293(21):2634-2640.

Weerasooriya R, Khairy P, Litalien J, et al. Catheter ablation for atrial fibrillation: are results maintained at 5 years of follow-up? J Am Coll Cardiol. 2011;57(2):160-166.

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Wilber DJ, Pappone C, Neuzil P, et al. Comparison of antiarrhythmic drug therapy and radiofrequency catheter ablation in patients with paroxysmal atrial fibrillation: a randomized controlled trial. JAMA. 2010;303(4):333-340.

Wyse DG, Waldo AL, DiMarco JP, et al. A comparison of rate control and rhythm control in patients with atrial fibrillation. N Engl J Med. 2002;347(23):1825-1833.

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Zhuang Y, Yong YH, Chen ML. Updating the evidence for the effect of radiofrequency catheter ablation on left atrial volume and function in patients with atrial fibrillation: a meta-analysis. JRSM Open. 2014;5(3):2054270414521185.

Zipes DP, Camm AJ, Borggrefe M, et al. ACC/AHA/ESC 2006 guidelines for management of patients with ventricular arrhythmias and the prevention of sudden cardiac death — Executive Summary. A report of the American College of Cardiology/American Heart Association Task Force and the European Society of Cardiology Committee for Practice Guidelines (Writing Committee to develop guidelines for management of patients with ventricular arrhythmias and the prevention of sudden cardiac death). Eur Heart J. 2006; 27(17): 2099-2140.





Coding

Inclusion of a code in this table does not imply reimbursement. Eligibility, benefits, limitations, exclusions, precertification/referral requirements, provider contracts, and Company policies apply.

The codes listed below are updated on a regular basis, in accordance with nationally accepted coding guidelines. Therefore, this policy applies to any and all future applicable coding changes, revisions, or updates.

In order to ensure optimal reimbursement, all health care services, devices, and pharmaceuticals should be reported using the billing codes and modifiers that most accurately represent the services rendered, unless otherwise directed by the Company.

The Coding Table lists any CPT, ICD-9, ICD-10, and HCPCS billing codes related only to the specific policy in which they appear.

CPT Procedure Code Number(s)

93650, 93653, 93654, 93655, 93656, 93657


Professional and outpatient claims with a date of service on or before September 30, 2015, must be billed using ICD-9 codes. Professional and outpatient claims with a date of service on or after October 1, 2015, must be billed using ICD-10 codes.

Facility/Institutional inpatient claims with a date of discharge on or before September 30, 2015, must be billed with ICD-9 codes. Facility/Institutional inpatient claims with a date of discharge on or after October 1, 2015, must be billed with ICD-10 codes.


ICD - 10 Procedure Code Number(s)

N/A


Professional and outpatient claims with a date of service on or before September 30, 2015, must be billed using ICD-9 codes. Professional and outpatient claims with a date of service on or after October 1, 2015, must be billed using ICD-10 codes.

Facility/Institutional inpatient claims with a date of discharge on or before September 30, 2015, must be billed with ICD-9 codes. Facility/Institutional inpatient claims with a date of discharge on or after October 1, 2015, must be billed with ICD-10 codes.


ICD -10 Diagnosis Code Number(s)

THE FOLLOWING DIAGNOSIS CODES ARE APPROPRIATE TO REPORT WITH CPT CODE 93650:


I45.89 Other specified conduction disorders

I47.1 Supraventricular tachycardia

I48.0 Paroxysmal atrial fibrillation

I48.1 Persistent atrial fibrillation

I48.2 Chronic atrial fibrillation

I48.3 Typical atrial flutter

I48.4 Atypical atrial flutter

I48.91 Unspecified atrial fibrillation

I48.92 Unspecified atrial flutter

I49.2 Junctional premature depolarization

I49.5 Sick sinus syndrome

I49.8 Other specified cardiac arrhythmias

THE FOLLOWING DIAGNOSIS CODES ARE APPROPRIATE TO REPORT WITH CPT CODE 93653:

I45.6 Pre-excitation syndrome

I45.89 Other specified conduction disorders

I47.1 Supraventricular tachycardia

I48.0 Paroxysmal atrial fibrillation

I48.1 Persistent atrial fibrillation

I48.2 Chronic atrial fibrillation

I48.3 Typical atrial flutter

I48.4 Atypical atrial flutter

I48.91 Unspecified atrial fibrillation

I48.92 Unspecified atrial flutter

I49.5 Sick sinus syndrome

I49.8 Other specified cardiac arrhythmias

THE FOLLOWING DIAGNOSIS CODES ARE APPROPRIATE TO REPORT WITH CPT CODE 93654:

I47.0 Re-entry ventricular arrhythmia

I47.2 Ventricular tachycardia

I49.3 Ventricular premature depolarization

THE FOLLOWING DIAGNOSIS CODES ARE APPROPRIATE TO REPORT WITH CPT CODE 93655:

I45.6 Pre-excitation syndrome

I45.89 Other specified conduction disorders

I47.0 Re-entry ventricular arrhythmia

I47.1 Supraventricular tachycardia

I47.2 Ventricular tachycardia

I48.0 Paroxysmal atrial fibrillation

I48.1 Persistent atrial fibrillation

I48.2 Chronic atrial fibrillation

I48.3 Typical atrial flutter

I48.4 Atypical atrial flutter

I48.91 Unspecified atrial fibrillation

I48.92 Unspecified atrial flutter

I49.3 Ventricular premature depolarization

I49.5 Sick sinus syndrome

I49.8 Other specified cardiac arrhythmias

THE FOLLOWING DIAGNOSIS CODES ARE APPROPRIATE TO REPORT WITH CPT CODE 93656:

I48.0 Paroxysmal atrial fibrillation

I48.1 Persistent atrial fibrillation

I48.2 Chronic atrial fibrillation

I48.3 Typical atrial flutter

I48.4 Atypical atrial flutter

I48.91 Unspecified atrial fibrillation

I48.92 Unspecified atrial flutter


THE FOLLOWING DIAGNOSIS CODES ARE APPROPRIATE TO REPORT WITH CPT CODE 93657:

I48.0 Paroxysmal atrial fibrillation

I48.1 Persistent atrial fibrillation

I48.2 Chronic atrial fibrillation

I48.3 Typical atrial flutter

I48.4 Atypical atrial flutter

I48.91 Unspecified atrial fibrillation

I48.92 Unspecified atrial flutter



HCPCS Level II Code Number(s)



C1732 Catheter, electrophysiology, diagnostic/ablation, 3D or vector mapping

C1733 Catheter, electrophysiology, diagnostic/ablation, other than 3D or vector mapping, other than cool-tip

C2630 Catheter, electrophysiology, diagnostic/ablation, other than 3D or vector mapping, cool-tip


Revenue Code Number(s)

N/A

Coding and Billing Requirements


Cross References


Policy History

11.02.06l:
02/23/2018This policy has undergone a routine review, and the medical necessity criteria have been revised as follows:
  • Symptomatic paroxysmal atrial fibrillation clarified as recurrent or greater than one episode, with four or less episodes in the previous six months.
  • Polymorphic ventricular tachycardia electrical "storm" also known as incessant ventricular tachycardia defined as at least three episodes of sustained ventricular tachycardia in a 24-hour period.


Effective 10/05/2017 this policy has been updated to the new policy template format.


Version Effective Date: 02/23/2018
Version Issued Date: 02/23/2018
Version Reissued Date: N/A

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