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

Introduction: Use 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. Methods: Inpatient 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. Results: We 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. Conclusions: The 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. ### Competing Interest Statement DJC reports institutional research grant support from Abbott, Boston Scientific, I-Rhythm, Edwards Lifescience, and Philips and consulting income from Abbott, Medtronic, Boston Scientific, and Edwards Lifesciences All other authors reported no relationships relevant to the contents of this paper to disclose. ### Funding Statement This study did not receive any funding. ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: This protocol was deemed exempt by the Institutional Review Board at Beth Israel Deaconess Medical Center. I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes Due to the restrictions of the data use agreement with Medicare under which this analysis was performed, study data cannot be shared with outside investigators.