Diagnostic Endocardial Electrical Stimulation (EES)
Separate payment should not be made for the HIS bundle cardiogram or an ECG when it is performed in conjunction with EES. If these services are itemized, the charges should be combined under procedure code 93618.

Catheter Ablation
Catheter ablation is an eligible procedure when performed for any of the following indications:

Indication	Procedure Codes	ICD-9 Code
Paroxysmal supraventricular tachycardia	93650, 93651	427.0
"Normal" supraventricular tachycardia	93651	426.81
Accessory bypass tract arrhythmia (Wolff-Parkinson-White Syndrome)	93651	426.7
Radiofrequency catheter ablation or modification of the atrioventricular junction for ventricular rate control of symptomatic atrial tachyarrhythmias	93650	427.89
Symptomatic sustained atrioventricular nodal reentrant tachycardia	93650, 93651	426.89
Atrial tachycardia or atrial flutter	93650, 93651	427.32
Patients without structural heart disease (i.e., ischemic or idiopathic cardiomyopathy) with symptomatic sustained monomorphic ventricular tachycardia; or bundle branch reentrant ventricular tachycardia	93652	427.1
Ischemic or idiopathic cardiomyopathy with ventricular tachycardia	93651, 93652	414.8, 425.4
Atrial ablation for elimination of atrial fibrillation	93650, 93651	427.31
Pulmonary vein isolation	93799	427.31

Operative Ablation
Operative ablation (codes 33250-33261) is an eligible surgical service which may be used to eliminate arterioventricular conduction defects (426.0, 426.10-426.13).

The Maze procedure entails making incisions in the heart that:

• direct an impulse from the sinoatrial (SA) node to the atrioventricular (AV) node;
• preserve activation of the entire atrial myocardium; and
• block reentrant impulses that are responsible for atrial fibrillation or flutter.
  

Description

Diagnostic Endocardial Electrical Stimulation (EES)
Diagnostic endocardial electrical stimulation (pacing), also called programmed electrical stimulation of the heart, is a covered diagnostic medical service when used for patients with severe cardiac arrhythmias. The principal use for EES is in the diagnosis and treatment of sustained ventricular tachycardia. EES is also employed to study cardiac arrhythmias and to identify patients at risk of sudden arrhythmic death.

EES includes the insertion of intracardiac electrode catheters, intracardiac and extracardiac recordings, and a stimulator device. In addition, an intra-catheter HIS bundle cardiogram (codes 93600) is usually obtained during EES, as are conventional electrocardiograms (code 93000).

Catheter Ablation
Catheter ablation (93650-93652), is a therapeutic technique using a tripolar electrode catheter to eliminate conduction defects. This technique involves a high level of current which is channeled through a catheter to burn and destroy the arrhythmic area of the heart. This procedure is performed on those patients who prove resistant or intolerant to pharmacological care or other means of treatment.

Operative Ablation
This procedure is performed through an incision to ablate (destroy) the arrhythmic area of the heart.

The Maze procedure (code 33253) represents the surgical treatment of atrial fibrillation or flutter (427.31-427.32) for patients who do not respond to medical treatment.

NOTE:

This policy is designed to address medical guidelines that are appropriate for the majority of individuals with a particular disease, illness, or condition. Each person's unique clinical circumstances may warrant individual consideration, based on review of applicable medical records.

Under the Federal Employee Program, all services that utilize FDA-approved drugs, devices, or biological products are eligible when intended for the treatment of a serious or life-threatening condition and when medically necessary and appropriate for the patient’s condition. Radiofrequency catheter ablation used for conditions other than those listed as eligible on this policy is considered an eligible service when determined medically necessary based on the patient’s condition. In addition, radiofrequency catheter ablation of pulmonary veins for atrial fibrillation may be considered an eligible service when determined to be medically necessary based on the patient's condition.

PRN References

10/1993, Catheter ablation, reimbursement and codes for
12/1995, Intracardiac catheter ablation, reimbursement for 1
02/1996, Maze procedure, code and reporting of
10/2001, Catheter ablation