BAT Therapy

This edition of “Spotlight on CPT” will provide information on BAT therapy. BAT stands for baroreflex activation therapy and is an autonomic nervous system modulation system. This therapy treats heart failure with reduced ejection fraction (HFrEF) and resistant hypertension.

The BAT system is composed of a lead which is implanted on the carotid sinus and then tunneled to a generator which is implanted in the chest. The generator delivers programmed electrical impulses to the baroreceptors in the carotid sinus. The baroreceptors are sensory nerves that are specialized and will increase the parasympathetic nervous system (rest response) and decrease the sympathetic nervous system (fight or flight response). The effects can include a lower heart rate and improved exercise capacity for HFrEF patients.

There is a video on this webpage: baroreflex-activation-therapy-a-novel-extravascular-procedure-for-heart-failure-patients that shows how the baroreflex activation therapy works.

In 2026, CPT has included these codes for the BAT procedure: 

64654   Initial open implantation of baroreflex activation therapy (BAT) modulation system, including lead placement onto the carotid sinus, lead tunnelling, connection to a pulse generator placed in a distant subcutaneous pocket (ie, total system), and intraoperative interrogation and programming

Should programming be carried out on a different encounter date, it should be reported with codes

93145 or 93146.

 

93145   Interrogation device evaluation (in person), carotid sinus baroreflex activation therapy (BAT) modulation system including telemetric iterative communication with the implantable device to monitor device diagnostics and programmed therapy values, with interpretation and report (eg, battery status, lead impedance, pulse amplitude, pulse width, therapy frequency, pathway mode, burst mode, therapy start/stop times each day), without programming

93146                    with programming, including optimization of tolerated therapeutic level setting

 

64655   Revision or replacement of baroreflex activation therapy (BAT) modulation system, with intraoperative interrogation and programming; lead only

64656                    pulse generator only

 

64657   Removal of baroreflex activation therapy (BAT) modulation system; total system

64658                    lead only

64659                    pulse generator only

 

As with any implantation system, coding professionals should be aware of which components are being

inserted, revised, replaced, or removed when assigning procedure codes. 

Now, light has been shed on BAT therapy procedures.

About the Author

Dianna Foley, RHIA, CCS, CDIP, CHPS, has 25 years of HIM experience. She earned her bachelor’s degree from the University of Cincinnati and holds RHIA, CHPS, CDIP, and CCS certifications from AHIMA. Dianna’s an AHIMA-approved ICD-10-CM/PCS trainer, an AHIMA-published author, a participant in AHIMA credential item writing and exam development, and served on the AHIMA Nominating Committee. Dianna has held various HIM positions and is now an independent coding consultant. She previously served as a program director for Medical Coding and HIT. She presents on coding topics at the national, state, and regional levels and serves as OHIMA’s Education Coordinator.

Fluoroquinolone Antibiotics

Today, “In the kNOW” will be looking at recent guidance and coding changes related to the use of fluoroquinolone antibiotics.

With the October 1st, 2025 ICD-10-CM coding updates, the Table of Drugs and Chemicals was updated with new codes to cover poisonings, adverse effects, and underdosing related to the use of fluoroquinolone antibiotics. These are a type of antibiotic used to treat bacterial infections and are considered broad-spectrum meaning they can be used to treat both gram-negative and gram-positive infections. Coding professionals may be more familiar with the brand-names of these antibiotics including Cipro, Levaquin, and Avelox to name a few.

Here are the new codes:

T36.AX1- Poisoning by fluoroquinolone antibiotics, accidental (unintentional)

     Poisoning by fluoroquinolone antibiotics NOS

T36.AX2- Poisoning by fluoroquinolone antibiotics, intentional self-harm
T36.AX3- Poisoning by fluoroquinolone antibiotics, assault
T36.AX4- Poisoning by fluoroquinolone antibiotics, undetermined
T36.AX5- Adverse effect of fluoroquinolone antibiotics
T36.AX6- Underdosing of fluoroquinolone antibiotics

Here is a brief coding scenario:
A woman was discharged from the hospital on Cipro for her cystitis. Her husband began to feel unwell and took some of her medication. Shortly after taking the Cipro, he developed tremors and experienced visual hallucinations. Which of the above listed codes should be assigned?

Because the husband took medication that was not intended for him, this event is considered a poisoning. Code T36.AX1A should be assigned. This code would be sequenced first followed by G25.1 (drug-induced tremor) and R44.1 (visual hallucinations).

If we take the same the scenario and now have the wife experience the visual hallucinations and tremors, the coding and sequencing changes. This would be an adverse effect, since the medication had been properly prescribed and taken. In this scenario, sequence either the visual hallucinations or the tremors first, followed by T36.AX5A for the adverse effect of the fluoroquinolone antibiotics. 

Now you are In the kNOW!!

 

About the Author

Dianna Foley, RHIA, CCS, CDIP, CHPS, has 25 years of HIM experience. She earned her bachelor’s degree from the University of Cincinnati and holds RHIA, CHPS, CDIP, and CCS certifications from AHIMA. Dianna’s an AHIMA-approved ICD-10-CM/PCS trainer, an AHIMA-published author, a participant in AHIMA credential item writing and exam development, and served on the AHIMA Nominating Committee. Dianna has held various HIM positions and is now an independent coding consultant. She previously served as a program director for Medical Coding and HIT. She presents on coding topics at the national, state, and regional levels and serves as OHIMA’s Education Coordinator.