Abstract 17978: Validation of Contemporary Administrative Codes for Identifying Pulmonary Vein Isolation Procedures

Abstract

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, contemporary procedural codes for identifying PVI have not been validated. 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-10 th Revision Procedure Coding System (ICD-10 PCS) claims submitted by healthcare facilities to bill for each PVI. We performed the reverse for commonly matched ICD-10-PCS codes, to identify their corresponding CPT-billed procedures. Results: We identified 20,388 inpatient PVIs from 1/2017 to 12/2020, of which 14,468 (71%) were linked to MedPAR by same-day procedure date. Of these, 13,156 (91%) were billed as ICD-10 02583ZZ “ Destruction of Conduction Mechanism, Percutaneous Approach ”, with lower use of other codes. However, 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 (Figure). Conclusions: Compared with CPT codes as a gold standard, 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 not sensitive or specific for identifying PVI in claims, and cannot be reliably used in isolation for health services research on this important procedure.