Society Successfully Opposes Proposed NCCI Edits Involving Catheter Ablation Procedures

On April 16, 2009, The Heart Rhythm Society received a letter from the National Correct Coding Initiative (NCCI) regarding the Centers for Medicaid and Medical Services (CMS) proposal to bundle the ablation family of CPT codes (93650-93652) with CPT codes for recording, pacing and electrophysiology study (93600-93603, 93610-93612, 93618-93623) and to change the modifier indicator status from “1” to “0” on existing edits. The Society commented extensively in a letter dated June 18, 2009. [Read Society comment letter, PDF, 149K]

The edits were scheduled for implementation in NCCI Version 15.3 effective October 1, 2009. Had the edits been implemented, they would not have allowed for use of NCCI-associated modifiers. In its written response, the Society strongly opposed the proposal, expressing concern about the impact the change would have on medical decision making and the potential threat to patient access to critical services for the treatment of cardiac arrhythmias.

Equally important, if not more, the proposed edits were a direct contradiction to the coding conventions and instructions in the CPT guidelines. Among the guidelines statements is the following: “Electrophysiology study (ies), mapping and ablation represents distinctly different procedures, requiring individual reporting whether performed on the same or subsequent dates.”

After reviewing the Society’s comments, CMS withdrew the proposal in its entirety.

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