CPT® Code 93651 | Case2Code

Code deleted, see 93653-93657

Official Description

Intracardiac catheter ablation of arrhythmogenic focus; for treatment of supraventricular tachycardia by ablation of fast or slow atrioventricular pathways, accessory atrioventricular connections or other atrial foci, singly or in combination

Common Language Description

Intracardiac catheter ablation of an arrhythmogenic focus is a specialized medical procedure aimed at treating supraventricular tachycardia, a condition characterized by an abnormally fast heart rate originating above the ventricles. This procedure involves the targeted destruction of specific electrical pathways within the heart that contribute to the arrhythmia. The ablation process can address both fast and slow atrioventricular pathways, as well as accessory atrioventricular connections and other atrial foci, either individually or in combination. The procedure typically begins with the identification and mapping of the anomalous or accessory pathways, which is crucial for understanding the arrhythmia cycle. Following this mapping, ablation catheters are carefully inserted and positioned along the identified pathways using either a transaortic or transseptal approach. The application of radiofrequency or cryoablation energy is then utilized to disrupt the electrical conduction through these pathways, effectively aiming to eliminate the source of the arrhythmia. Throughout the procedure, attempts are made to induce the arrhythmia to confirm the effectiveness of the ablation, and if arrhythmia is induced, the catheter may be repositioned for further ablation. This process continues until the anomalous pathway is completely obliterated, as evidenced by the inability to induce the arrhythmia. It is important to note that a different code, 93652, should be used when the procedure is performed to treat life-threatening ventricular tachycardia.

1. Indications

The procedure of intracardiac catheter ablation of an arrhythmogenic focus is indicated for the treatment of supraventricular tachycardia. This condition may manifest through various symptoms, including but not limited to palpitations, dizziness, shortness of breath, and in some cases, syncope. The procedure is specifically aimed at addressing the underlying arrhythmogenic foci that contribute to the abnormal heart rhythms.

Supraventricular Tachycardia The primary indication for this procedure is the presence of supraventricular tachycardia, which is characterized by an elevated heart rate originating from above the ventricles.

2. Procedure

The procedure of intracardiac catheter ablation involves several critical steps to ensure effective treatment of the arrhythmogenic focus.

Step 1: Identification and Mapping Initially, the anomalous or accessory pathway responsible for the arrhythmia is identified and mapped. This step is essential for understanding the specific electrical circuits involved in the arrhythmia cycle.
Step 2: Catheter Insertion Following mapping, ablation catheters are inserted into the heart. These catheters are positioned along the identified anomalous pathways using either a transaortic or transseptal approach, which allows for precise targeting of the arrhythmogenic focus.
Step 3: Application of Ablation Energy Once the catheters are in place, radiofrequency or cryoablation energy is applied. This energy disrupts the electrical conduction through the anomalous or accessory atrioventricular pathways, effectively aiming to eliminate the source of the arrhythmia.
Step 4: Induction of Arrhythmia An attempt is made to induce the arrhythmia during the procedure. If arrhythmia occurs, the catheter is repositioned to target the specific area of conduction that needs further ablation.
Step 5: Repeated Ablation The process of repositioning the catheter and applying ablation energy is repeated as necessary until the anomalous pathway has been obliterated. This is confirmed by the inability to induce the arrhythmia, indicating successful treatment.

3. Post-Procedure

After the intracardiac catheter ablation procedure, patients are typically monitored for any immediate complications and to assess the effectiveness of the treatment. Post-procedure care may include observation in a recovery area, where vital signs are closely monitored. Patients may experience some discomfort or minor complications, which are generally managed with standard post-operative care. Follow-up appointments are essential to evaluate the long-term success of the ablation and to monitor for any recurrence of arrhythmia. Additional considerations may include lifestyle modifications and medication adjustments as deemed necessary by the healthcare provider.

Short Descr	ABLATE HEART DYSRHYTHM FOCUS
Medium Descr	ABLATE HEART DYSRHYTHM FOCUS
Long Descr	Intracardiac catheter ablation of arrhythmogenic focus; for treatment of supraventricular tachycardia by ablation of fast or slow atrioventricular pathways, accessory atrioventricular connections or o
Status Code	Active Code
Global Days	000 - Endoscopic or Minor Procedure
PC/TC Indicator (26, TC)	0 - Physician Service Code
Multiple Procedures (51)	2 - Standard payment adjustment rules for multiple procedures apply.
Bilateral Surgery (50)	0 - 150% payment adjustment for bilateral procedures does NOT apply.
Physician Supervisions	09 - Concept does not apply.
Assistant Surgeon (80, 82)	0 - Payment restriction for assistants at surgery applies to this procedure...
Co-Surgeons (62)	0 - Co-surgeons not permitted for this procedure.
Team Surgery (66)	0 - Team surgeons not permitted for this procedure.
Diagnostic Imaging Family	99 - Concept Does Not Apply
APC Status Indicator	Discontinued Code
Type of Service (TOS)	2 - Surgery
Berenson-Eggers TOS (BETOS)	none
MUE	Not applicable/unspecified.
CCS Clinical Classification	225 - Conversion of cardiac rhythm