Society Expresses Concerns Over Denials Despite Correct Coding

Draft of letter available on request for use by Society members

In response to the denial of claims when physician offices appropriately use the CPT code 93462 in conjunction with invasive cardiac electrophysiology procedures, the Heart Rhythm Society sent letters to Medicare Administrative Contractors around the country strongly recommending an update to the policy on CPT code 93462. The Society requested a review and update of the Local Coverage Decision developed for cardiac catheterization to facilitate removal of barriers to the appropriate use of 93462, specifically during catheter ablation procedures performed to cure arrhythmias in the left-sided chambers of the heart.

The inception of this code was in response to a directive to develop new codes related to cardiac catheterization. This code became effective January 1, 2011. A primary reason for developing the new catheterization codes was to provide clarity and appropriate coding for the transseptal approach by development of an "add-on" code that could also be submitted in conjunction with the catheter ablation codes of 93651 (catheter ablation of SVT and 93652 (catheter ablation of VT). However, current policy fails to recognize the associated appropriate medical necessity. There is an absence of a local coverage decision, which incorporates the appropriate CPT codes in conjunction with 93651 or 93652, as approved indications to enable reimbursement for performing transseptal catheterization.

On March 15, 2011, the Society sent letters (see sample letter, PDF, 119K) to 15 local Medicare carriers recommending a review and update of the policy to acknowledge these widely accepted, clinically indicated practices. The Society suggested that the local coverage decisions on performing transseptal catheterization (93462) are amended to include supraventricular tachycardia (427.0), ventricular tachycardia (427.1), and atrial fibrillation and atrial flutter (427.31, 427.32) as appropriate crossover indications.

If you would like a copy of the letter sent to your local Medicare carriers, please e-mail Isabelle Le Blanc, Manager, Health Policy.

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