Updated January 11, 2010
NCCI Implemented Edits for Ablation in Error
Effective January 1, 2010, the Centers for Medicare and Medicaid Services (CMS) posted National Correct Coding Initiative (NCCI, Version 16.0) edits to its website that will bundle CPT codes for catheter ablation (93650-93652) with codes for recording, pacing and electrophysiology study (93600-93603, 93610-93612, 93618-93623) and change the modifier indicator status from “1” to “0” on existing edits. The Society immediately brought this issue to the attention of CMS, which owns NCCI and makes all decisions about its content, with the request to retroactively remove this restriction.
We have been informed that CMS implemented the edits in error and they will be deleted in NCCI Version 16.1 scheduled for April 1, 2010 with deletion retroactive to the implementation date of the edits (January 1, 2010).
CMS has instructed physicians to delay submission of their claims for the following code combinations until Version 16.1 is implemented on April 1, 2010. If a claim is submitted and denied based on these edits, physicians may resubmit the claim or appeal it after April 1 when the retroactive deletion will appear in the claims processing contractor NCCI files.
In Version 16.0, several electrophysiologic studies are bundled as inclusive components of an AV Node and VT Ablation. Only component codes for atrial or ventricular pacing are bundled with SVT Ablation. All code pair edits have been assigned a modifier indicator of “0” signifying that NCCI-associated modifiers cannot be used to override the edit pairs. A modifier indicator of “0” also establishes that you should only report the service in Column 2. The impacted codes are as follows:
| AV Node Ablation |
| Column 1 | Column 2 | Electrophysiologic Studies | Effective
Date | Modifier
Indicator |
| 93650 | 93602 | Intra-atrial record | 01/01/2010 | 0 |
| 93650 | 93603 | Right ventricular record | 01/01/2010 | 0 |
| 93650 | 93610 | Intra atrial pace | 01/01/2010 | 0 |
| 93650 | 93612 | Intraventricular pace | 01/01/2010 | 0 |
| 93650 | 93618 | Induction attempt | 01/01/2010 | 0 |
| 93650 | 93619 | Comp EPS no induction attempt | 01/01/2010 | 0 |
| 93650 | 93620 | Comp EPS | 01/01/2010 | 0 |
| 93650 | 93621 | LA record | 01/01/2010 | 0 |
| 93650 | 93622 | LV record | 01/01/2010 | 0 |
| 93650 | 93623 | Stimulation and pace after meds | 01/01/2010 | 0 |
| SVT Ablation |
| Column 1 | Column 2 | Electrophysiologic Studies | Effective
Date | Modifier
Indicator |
| 93651 | 93610 | Intra atrial pace | 01/01/2010 | 0 |
| 93651 | 93612 | Intraventricular pace | 01/01/2010 | 0 |
| VT Ablation |
| Column 1 | Column 2 | Electrophysiologic Studies | Effective
Date | Modifier
Indicator |
| 93652 | 93600 | HIS record | 01/01/2010 | 0 |
| 93652 | 93602 | Intra-atrial record | 01/01/2010 | 0 |
| 93652 | 93603 | Right ventricular record | 01/01/2010 | 0 |
| 93652 | 93610 | Intra atrial pace | 01/01/2010 | 0 |
| 93652 | 93612 | Intraventricular pace | 01/01/2010 | 0 |
| 93652 | 93618 | Induction attempt | 01/01/2010 | 0 |
Note: A comprehensive diagnostic electrophysiologic evaluation must include those services used to derive diagnostic information as described by codes 93600, 93602, 93603, 93610, and 93612. For 93620, an attempted arrhythmia induction must also be included with all of the above. For 93619, all of the above must be included except for an attempted arrhythmia induction. As long as all of the components of a comprehensive electrophysiologic evaluation are performed, billing for SVT ablation should not be impacted by the temporary NCCI edits.
