Atrial flutter ablation cpt6/18/2023 However, with new technology and clinical practices, these services are now nearly universally performed with SVT and/or AFib ablations.Īs such, while the CPT code numbers remain the same for these services, two of the five codes underwent significant revisions of code descriptors to incorporate (bundle) related services. When the current codes and descriptors were written in 2011, 3D mapping, left-atrial pacing and ICE were not typically performed with the underlying ablations. While the growth in services is appropriate and reflects evolving patterns of care in the past decade, it also reflects changes in performance of the services themselves. Through its ongoing review of potentially misvalued services, the AMA RUC in 2019 flagged EP ablation services for scrutiny because of significant growth in volume. RUC Recommendations From Resurvey Service In 2023, some values could go up slightly and others down slightly from what CMS finalized for 2022 if data from the second survey and recommendations are adopted. Information from the resurvey generally aligned with the first survey in showing large reductions in time. The agency also indicated additional changes could be made for 2023 based on information from the resurvey, which was not incorporated into 2022 rates. While additional survey information was available from a resurvey for the April 2021 American Medical Association RVU Update Committee (RUC) meeting to check the accuracy of the January 2021 surveys, CMS finalized its proposal to maintain the current work RVUs of SVT code 93653 and AF code 93656, while discounting the work of the bundled components for 2022. However, the final rule made no changes to the original proposal. The ACC also submitted formal written comments explaining information from a second work RVU survey and recommending a phase-in of reductions. The ACC and Heart Rhythm Society (HRS) staff and member leaders met multiple times with various agency officials and members of Congress to share information, questions and concerns on the physician fee schedule to ensure work RVU recommendations were clearly understood and informed by the best available information. These reductions essentially eliminate separate payment for 3D mapping, left-atrial pacing, and intracardiac echocardiography (ICE) when performed with supraventricular tachycardia (SVT) ablation and atrial fibrillation (AFib) ablation, as shown in the table below. Success rates were 83% in patients without and 73% in patients with inducible arrhythmias at the end of the procedure (p=NS).ĬTI ablation, in addition to PV isolation, significantly reduced the number of patients with inducible atrial arrhythmias and inducible AF.As part of the 2022 Medicare Physician Fee Schedule final rule, the Centers for Medicare and Medicaid Services (CMS) implemented reductions to work relative value units (RVUs) for electrophysiology (EP) ablation services without any modifications. After one year of follow-up, 23 patients (79%) had no recurrence of arrhythmia. 9/29, p=0.016) and of combined AF and atypical AFL inducibility (19 vs. There was a significant reduction of AF inducibility (16 vs. After CTI ablation, only 11 patients (38%) maintained arrhythmia inducibility (p<0.001)-AF in nine and atypical AFL in two. Of the 29 patients, 26 (90%) had an inducible arrhythmia before CTI ablation-AF in 16, typical atrial flutter (AFL) in seven and atypical AFL in three. Atrial arrhythmias were considered inducible if they persisted for more than 60 seconds. Atrial arrhythmia inducibility was tested with burst pacing down to 150 ms or atrial refractoriness from the proximal coronary sinus. The procedure was performed using a CARTO-Merge mapping system, one or two Lasso catheters, an irrigated ablation catheter and radiofrequency energy. In 29 consecutive patients (23 male, mean age 54.6+/-11.4 years, 11 (38%) with hypertension and four (14%) with structural heart disease, mean left atrial dimension 43+/-6 mm) undergoing PV isolation for paroxysmal or persistent AF, atrial arrhythmia inducibility was tested before and after CTI ablation. The aim of this study is to assess whether CTI ablation after PV isolation reduces inducibility of atrial arrhythmias, particularly AF. Non-inducibility after AF ablation is associated with a higher success rate. A cavotricuspid isthmus (CTI) block may be an easier and safer alternative to left atrial lines for this purpose. In AF ablation, after pulmonary vein (PV) isolation, substrate modification can be increased by performing linear lesions in the left atrium that reduce the fibrillatory surface. Maintenance of atrial fibrillation (AF) depends on the presence of multiple reentrant circuits in the atria.
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