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, 426.82
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 for management of atrial fibrillation	93799	427.31

Operative Ablation
Operative ablation (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 (33254, 33255, 33256) 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.
  

For the endoscopic approach, 33265 or 33266 should be reported.

The eligibility of the MAZE procedure should be determined on an individual consideration (IC) basis. Medical records must indicate that the patient did not respond to other medical treatments or those treatments were contraindicated.

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 (93600) is usually obtained during EES, as are conventional electrocardiograms (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 (33254, 33255, 33256) represents the surgical treatment of atrial fibrillation or flutter (427.31-427.32) for patients who do not respond to medical treatment.

MAZE ablation and reconstruction can be either limited or extensive.

Limited operative ablation and reconstruction include:

1. Surgical isolation of triggers of supraventricular dysrhythmias by operative ablation that isolates the pulmonary veins or other anatomically defined triggers in the left or right atrium.

Extensive operative ablation and reconstruction include:

1. The services included in “limited” above;
2. Additional ablation of atrial tissue to eliminate sustained supraventricular dysrhythmias. This must include operative ablation that involves the right atrium, the atrial septum, or left atrium in continuity with the atrioventricular annulus.

MAZE can also be performed through an endoscopic approach (33265, 33266).

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.

This medical policy may not apply to FEP. Medical policy is not an authorization, certification, explanation of benefits, or a contract. Benefits are determined by the Federal Employee Program.

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