Contemporary Administrative Codes For Identifying Pulmonary Vein Isolation Procedures for Atrial Fibrillation

IntroductionUse of pulmonary vein isolation (PVI) to treat atrial fibrillation continues to grow. Despite great interest in leveraging administrative data for real-world analyses, reliability of contemporary procedural codes for identifying PVI have not been carefully examined. MethodsInpatient PVIs were identified among US Medicare fee-for-service beneficiaries using Current Procedural Terminology (CPT) code 93656 in the Carrier Line Files. Each patient was cross-matched by procedure date with claims from Medicare Provider Analysis and Review Files (MedPAR) in order to compare CPT claims with International Classification of Diseases-10th Revision Procedure Coding System (ICD-10-PCS) claims submitted by healthcare facilities to bill for the same procedure. We performed the reverse analysis for commonly matched ICD-10-PCS codes to identify their corresponding CPT-billed procedures. Lastly, we reviewed a random selection of 100 institutional cases for additional comparison of CPT and ICD-10-PCS assignation. ResultsWe identified 25,617 inpatient PVIs from 1/2017 to 12/2021, of which 18,165 (71%) were linked to MedPAR by same-day procedure date. Of these, 16,672 (92%) were coded as ICD-10 02583ZZ "Destruction of Conduction Mechanism, Percutaneous Approach", with lower use of other codes. The reverse process yielded heterogeneous results: among 75,003 procedures billed as ICD-10 02583ZZ, only 15,691 (21%) matched with CPT 93656 (PVI), as several other procedures were interchangeably billed under this same ICD-10 code. Institutional case review confirmed the greater specificity of CPT codes for identifying PVIs. ConclusionsThe ICD-10-PCS code most commonly associated with CPT-billed PVI procedures actually refers to ablation of the atrio-ventricular junction. Yet this same ICD-10-PCS code also matches with a wide range of other procedures distinct from PVI. We conclude that ICD-10-PCS codes alone are neither sensitive nor specific for identifying PVIs in claims. CPT codes should be used for health services research on this important procedure.