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Wiki 33285/33286
- Thread starter KoBee
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such78
Expert
I got this via 3M
CPT Assistant, April 2019 Page: 3 Category:
Coding Changes to Cardiac Event Recorder Procedures
Important changes were made in the Subcutaneous Cardiac Rhythm Monitor subsection of the Cardiovascular System of the Current Procedural Terminology (CPT®) 2019 code set to address the advances made in technology for subcutaneous cardiac event rhythm monitors. Two codes (33282, 33284) were deleted and replaced by two new codes to report the insertion (33285) and the removal (33286) of a subcutaneous cardiac rhythm monitor, and new guidelines and parenthetical notes instructing users of the appropriate codes to report were added. This article provides an overview of these changes.
Subcutaneous Cardiac Rhythm Monitor
Technological advances made over the last decade for subcutaneous cardiac event rhythm monitors have resulted in smaller devices with more features. As a result, the use of older and larger monitor devices has steadily decreased to a low enough volume to warrant coding changes. While codes 33285 and 33286 refer to subcutaneous continuous cardiac rhythm monitors, these codes are also applicable for reporting implant and explant services associated with older implantable/insertable loop recorder (ILR) devices where medically appropriate. Code 33285 describes the subcutaneous insertion of a cardiac rhythm monitor, including the requisite programming. Code 33286 describes the complete removal of the monitor.
Subcutaneous cardiac rhythm monitors are used for long-term continuous cardiac monitoring in patients previously undiagnosed but suspected to be at high-risk for atrial fibrillation (AF) and stroke. AF is a common cardiac condition in which the heart beats irregularly or rapidly.1 Patients with AF are at risk of stroke because of small blood clots that may form in the heart and subsequently travel to the brain.
The following clinical examples and procedural descriptions reflect typical clinical scenarios for which these new codes would be appropriately reported.
Clinical Example (33285)
A 42-year-old female presents with a history of syncopal spells with inconclusive results using various investigations. The patient continues to have distressing symptoms every three to four months. A history and physical examination were performed. She was referred for insertion of a subcutaneous cardiac rhythm monitor.
Description of Procedure (33285)
Using blunt dissection, create a subcutaneous pocket the size and shape of the cardiac rhythm monitor using a specifically designed insertion tool or surgical instrument. Maintain hemostasis using standard techniques. Then insert the cardiac rhythm monitor into the pocket with an insertion tool or manually. Verify the ECG signal quality and amplitude by placing the programmer head in a sterile sleeve over the device, establishing telemetry. Evaluate the waveform on the programmer screen and adjust the gain to optimize waveform amplitude. Then close the incision with adhesive strips, surgical glue, staples, or subcuticular absorbable sutures, as needed. Dress the wound, program the cardiac rhythm monitor using a pacemaker programmer, and initiate recording.
Clinical Example (33286)
A 44-year-old female presents with a history of syncopal spells, the cause of which was recently diagnosed using a subcutaneous cardiac rhythm monitor. A history and physical examination were performed. The procedure, indications, potential complications, and alternatives were explained to the patient who appeared to understand and indicated the same. An opportunity for questions was provided and informed consent obtained.
Description of Procedure (33286)
Make a 1- to 2-cm incision through the previous implant incision. The operator tunnels under the skin to locate the device which typically migrates significantly from the site of original implant. Once located, debride extensive adhesions to free the device for removal. Cut any sutures anchoring the recorder to the subcutaneous tissue and remove the device from the pocket. Achieve hemostasis of the pocket and tunnel. Flush the pocket and tunnel and close with adhesive strips, surgical glue, staples, or subcuticular sutures as needed. Dress the wound.
References
1. Chugh S, Havmoeller R, Narayanan K, et al. Worldwide Epidemiology of Atrial Fibrillation: A Global Burden of Disease 2010 Study. Circulation. 2013;129(8):837-847. https://www.ahajournals.org/doi/full/10.1161/CIRCULATIONAHA.113.005119. Accessed March 18, 2019.
| Cardiac event recorder procedure changes |
Coding Changes to Cardiac Event Recorder Procedures
Important changes were made in the Subcutaneous Cardiac Rhythm Monitor subsection of the Cardiovascular System of the Current Procedural Terminology (CPT®) 2019 code set to address the advances made in technology for subcutaneous cardiac event rhythm monitors. Two codes (33282, 33284) were deleted and replaced by two new codes to report the insertion (33285) and the removal (33286) of a subcutaneous cardiac rhythm monitor, and new guidelines and parenthetical notes instructing users of the appropriate codes to report were added. This article provides an overview of these changes.
Subcutaneous Cardiac Rhythm Monitor
| 33285 | Insertion, subcutaneous cardiac rhythm monitor, including programming | ||
| 33286 | Removal, subcutaneous cardiac rhythm monitor | ||
| |||
Technological advances made over the last decade for subcutaneous cardiac event rhythm monitors have resulted in smaller devices with more features. As a result, the use of older and larger monitor devices has steadily decreased to a low enough volume to warrant coding changes. While codes 33285 and 33286 refer to subcutaneous continuous cardiac rhythm monitors, these codes are also applicable for reporting implant and explant services associated with older implantable/insertable loop recorder (ILR) devices where medically appropriate. Code 33285 describes the subcutaneous insertion of a cardiac rhythm monitor, including the requisite programming. Code 33286 describes the complete removal of the monitor.
Subcutaneous cardiac rhythm monitors are used for long-term continuous cardiac monitoring in patients previously undiagnosed but suspected to be at high-risk for atrial fibrillation (AF) and stroke. AF is a common cardiac condition in which the heart beats irregularly or rapidly.1 Patients with AF are at risk of stroke because of small blood clots that may form in the heart and subsequently travel to the brain.
The following clinical examples and procedural descriptions reflect typical clinical scenarios for which these new codes would be appropriately reported.
Clinical Example (33285)
A 42-year-old female presents with a history of syncopal spells with inconclusive results using various investigations. The patient continues to have distressing symptoms every three to four months. A history and physical examination were performed. She was referred for insertion of a subcutaneous cardiac rhythm monitor.
Description of Procedure (33285)
Using blunt dissection, create a subcutaneous pocket the size and shape of the cardiac rhythm monitor using a specifically designed insertion tool or surgical instrument. Maintain hemostasis using standard techniques. Then insert the cardiac rhythm monitor into the pocket with an insertion tool or manually. Verify the ECG signal quality and amplitude by placing the programmer head in a sterile sleeve over the device, establishing telemetry. Evaluate the waveform on the programmer screen and adjust the gain to optimize waveform amplitude. Then close the incision with adhesive strips, surgical glue, staples, or subcuticular absorbable sutures, as needed. Dress the wound, program the cardiac rhythm monitor using a pacemaker programmer, and initiate recording.
Clinical Example (33286)
A 44-year-old female presents with a history of syncopal spells, the cause of which was recently diagnosed using a subcutaneous cardiac rhythm monitor. A history and physical examination were performed. The procedure, indications, potential complications, and alternatives were explained to the patient who appeared to understand and indicated the same. An opportunity for questions was provided and informed consent obtained.
Description of Procedure (33286)
Make a 1- to 2-cm incision through the previous implant incision. The operator tunnels under the skin to locate the device which typically migrates significantly from the site of original implant. Once located, debride extensive adhesions to free the device for removal. Cut any sutures anchoring the recorder to the subcutaneous tissue and remove the device from the pocket. Achieve hemostasis of the pocket and tunnel. Flush the pocket and tunnel and close with adhesive strips, surgical glue, staples, or subcuticular sutures as needed. Dress the wound.
References
1. Chugh S, Havmoeller R, Narayanan K, et al. Worldwide Epidemiology of Atrial Fibrillation: A Global Burden of Disease 2010 Study. Circulation. 2013;129(8):837-847. https://www.ahajournals.org/doi/full/10.1161/CIRCULATIONAHA.113.005119. Accessed March 18, 2019.
I guess my understanding is, that if they remove and replace with a new one in a NEW separate incision, then we can unbundle the two, right!? but if they remove and replace from same incision, cannot unbundle?I got this via 3M
CPT Assistant, April 2019 Page: 3 Category:
Cardiac event recorder procedure changes
Coding Changes to Cardiac Event Recorder Procedures
Important changes were made in the Subcutaneous Cardiac Rhythm Monitor subsection of the Cardiovascular System of the Current Procedural Terminology (CPT®) 2019 code set to address the advances made in technology for subcutaneous cardiac event rhythm monitors. Two codes (33282, 33284) were deleted and replaced by two new codes to report the insertion (33285) and the removal (33286) of a subcutaneous cardiac rhythm monitor, and new guidelines and parenthetical notes instructing users of the appropriate codes to report were added. This article provides an overview of these changes.
Subcutaneous Cardiac Rhythm Monitor
33285 Insertion, subcutaneous cardiac rhythm monitor, including programming
33286 Removal, subcutaneous cardiac rhythm monitor
Technological advances made over the last decade for subcutaneous cardiac event rhythm monitors have resulted in smaller devices with more features. As a result, the use of older and larger monitor devices has steadily decreased to a low enough volume to warrant coding changes. While codes 33285 and 33286 refer to subcutaneous continuous cardiac rhythm monitors, these codes are also applicable for reporting implant and explant services associated with older implantable/insertable loop recorder (ILR) devices where medically appropriate. Code 33285 describes the subcutaneous insertion of a cardiac rhythm monitor, including the requisite programming. Code 33286 describes the complete removal of the monitor.
Subcutaneous cardiac rhythm monitors are used for long-term continuous cardiac monitoring in patients previously undiagnosed but suspected to be at high-risk for atrial fibrillation (AF) and stroke. AF is a common cardiac condition in which the heart beats irregularly or rapidly.1 Patients with AF are at risk of stroke because of small blood clots that may form in the heart and subsequently travel to the brain.
The following clinical examples and procedural descriptions reflect typical clinical scenarios for which these new codes would be appropriately reported.
Clinical Example (33285)
A 42-year-old female presents with a history of syncopal spells with inconclusive results using various investigations. The patient continues to have distressing symptoms every three to four months. A history and physical examination were performed. She was referred for insertion of a subcutaneous cardiac rhythm monitor.
Description of Procedure (33285)
Using blunt dissection, create a subcutaneous pocket the size and shape of the cardiac rhythm monitor using a specifically designed insertion tool or surgical instrument. Maintain hemostasis using standard techniques. Then insert the cardiac rhythm monitor into the pocket with an insertion tool or manually. Verify the ECG signal quality and amplitude by placing the programmer head in a sterile sleeve over the device, establishing telemetry. Evaluate the waveform on the programmer screen and adjust the gain to optimize waveform amplitude. Then close the incision with adhesive strips, surgical glue, staples, or subcuticular absorbable sutures, as needed. Dress the wound, program the cardiac rhythm monitor using a pacemaker programmer, and initiate recording.
Clinical Example (33286)
A 44-year-old female presents with a history of syncopal spells, the cause of which was recently diagnosed using a subcutaneous cardiac rhythm monitor. A history and physical examination were performed. The procedure, indications, potential complications, and alternatives were explained to the patient who appeared to understand and indicated the same. An opportunity for questions was provided and informed consent obtained.
Description of Procedure (33286)
Make a 1- to 2-cm incision through the previous implant incision. The operator tunnels under the skin to locate the device which typically migrates significantly from the site of original implant. Once located, debride extensive adhesions to free the device for removal. Cut any sutures anchoring the recorder to the subcutaneous tissue and remove the device from the pocket. Achieve hemostasis of the pocket and tunnel. Flush the pocket and tunnel and close with adhesive strips, surgical glue, staples, or subcuticular sutures as needed. Dress the wound.
References
1. Chugh S, Havmoeller R, Narayanan K, et al. Worldwide Epidemiology of Atrial Fibrillation: A Global Burden of Disease 2010 Study. Circulation. 2013;129(8):837-847. https://www.ahajournals.org/doi/full/10.1161/CIRCULATIONAHA.113.005119. Accessed March 18, 2019.
such78
Expert
In 3M, 33286 - NCCI Medicare FAC-Procedure code pair conflict with 33285 and is allowed if an appropriate NCCI modifier is present.
Last edited:
vidraj
Guru
Hi , I need some help with the same codes .
I gave 33285 and 33286 - 59 as per CCI Edit.
Cpt code 33285 was denied by medicare, as bundled to cpt code 33286 billed on the Same day rep stated to add appropriate modifier to 33285 to get unbundled .
What other modifier is missing or should I give 59 for both?
Can you suggest?
Thanks.
I gave 33285 and 33286 - 59 as per CCI Edit.
Cpt code 33285 was denied by medicare, as bundled to cpt code 33286 billed on the Same day rep stated to add appropriate modifier to 33285 to get unbundled .
What other modifier is missing or should I give 59 for both?
Can you suggest?
Thanks.
bhargavi
Guru
i use xu modifier on 33286 when both 33285,33286 are billed same day. we do this often
vidraj
Guru
Thank you Bhargavi. Will refile and see if it goes through.
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Hi , I reviewed one reference and cardiovascular coding guidelines which states :
- If the original subcutaneous rhythm monitor is removed and a new device placed through the same incision, code for the insertion of the new device only (33285). I would apply this same guideline even if there is some “tunneling” under the surface of the skin to create a new pocket for the replacement device– one incision equals code 33285 only.
- If, however, the old subcutaneous rhythm monitor is removed and a new device is placed through a separate incision you can report 33285 and 33286 with modifier 59 (or modifier XS) to show that the new device is inserted through one incision and the old device removed through a separate incision at a separate anatomic site. As an example, you may see this in patients who have an infection in the location where the original monitor was inserted with a need to move the new device to a completely different location away from the infection.
- You could also report 33285 and 33286 with modifier 59 (or modifier XE) if for some reason the old monitor was removed during one encounter and the new monitor was inserted at a separate encounter later on the same day. This would be very rare, but I did want to cover the coding of this scenario in case you see it in your coding.