May 22, 2017


Patient is scheduled for an ablation for PVI, but was in atrial flutter when he arrived in the lab, so the atrial flutter was ablated before the PVI. Can we bill for code 93655 when it is performed before the primary PVI? The physician's documentation is as follows: "The patient arrived at the clinical electrophysiology laboratory in atrial flutter with a ventricular rate of 85 beats per minute. The QRS width was measured at 90 milliseconds, and a QT interval was measured at 320 milliseconds. The HV interval was measured at 52 milliseconds. The attrial flutter showed concentric left atrial activation and counterclockwise rotation of the right atrium, negative sawtooth waves in leads II and III, and a VF and positive in lead V1. Utilizing Carto 3-dimensional mapping as a guide, energy was then targeted in a linear fashion from the tricuspid, mid isthmus to the inferior vena cava. This resulted in termination of the tachycardia. We then turned our attention to the primary arrhythmia, which was the atrial fibrillation and proceeded with the pulmonary vein ablation."

Question ID: 9283
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