May 2017 Q & A

Question: 96374 with an Ablation

We had a case where Ibutilide was administered during an atrial flutter ablation procedure (93653). The Medicare claims processing manual, chapter 4, section 230.2 discusses this and says, "Hospitals should report all HCPCS codes that describe the drug administration services provided, regardless of whether or not those services are separately paid or their payment is packaged." 93653 had a "J1". 96374 has an SI of "S".

In your opinion, Ibutilide is inherent or not inherent to an ablation procedure, in which it's not always used as part of the procedure, to lets say contrast to an diagnostic angiography, is it then ok to bill 96374 for an IV push, and 96365 for an infusion, if they are given Ibutilide as part of an ablation for a flutter or A-Fib?

 

Answer:

Injections performed during an invasive procedure are not reported separately. From the NCCI Manual:

“4. A number of diagnostic and therapeutic cardiovascular procedures (e.g., CPT codes 92950-92998, 93451-93533, 93600-93624, 93640-93657) routinely utilize intravenous or intra-arterial vascular access, routinely require electrocardiographic monitoring, and frequently require agents administered by injection or infusion techniques. Since these services are integral components of the more comprehensive procedures, codes for routine vascular access, ECG monitoring, and injection/ infusion services are not separately reportable.”

IF the only procedure performed was in the dorsalis pedis, it is an intervention in the anterior tibial artery distribution and would be coded as such. Interventions in the AT and the dorsalis pedis artery are additive into a single code (e.g., atherectomy in the DP and stent in the AT = stent with atherectomy in the anterior tibial distribution).