Rethink Pacemaker and Defibrillator Coding in 2012

New usage and definitions have changed code selection significantly from 2011.

By David B. Dunn, MD, FACS, CIRCC, CPC-H, CCC

Once again in 2012, CPT® includes significant changes to codes for pacemakers and cardioverter-defibrillators, including nine new codes, 14 code revisions (several of which completely change code use in comparison to 2011), and new definitions for pacemakers and defibrillators. A single lead system now denotes pacing and sensing in one chamber; a dual lead system denotes pacing and sensing in two chambers; and a multiple lead system denotes pacing and sensing in three or more chambers.

The best way to evaluate the new and revised codes is to group them according to the procedures performed (new codes are indicated with a circle; revised codes are indicated with a triangle).

The codes for the insertion of a generator only when the existing leads are already in place are:

Pacemaker   Defibrillator

33212                 33240           Existing single lead

33213                 33230          Existing dual leads

33221                  33231          Existing multiple leads

Notes:

– Use of these codes is expected to be infrequent.

– No generator is removed with these codes.

The codes for the removal of an existing generator and its replacement with a new generator for battery depletion/end-of-life indicators are:

Pacemaker   Defibrillator

33227                 33262          Single lead system

33228                 33263          Dual lead system

33229                 33264          Multiple lead system

Notes:

– No leads are inserted or replaced with these codes.

– Removal codes 33233 and 33241 are not reported with these codes.

The codes for the insertion of the initial system or replacement of the existing generator and new lead(s) are:

Pacemaker

33206  New generator and right atrial lead

33207  New generator and right ventricular lead

33208  New generator and right atrial and ventricular leads

Defibrillator

33249  New generator and lead(s) in right atrium and/or ventricle

Notes:

– Report 33233 (pacemaker) or 33241 (defibrillator) when an existing generator is removed. An exception occurs for an upgrade from single pacemaker to dual pacemaker; report 33214, which includes removal of existing generator, a new lead, and a new generator.

The codes for an extraction of transvenous leads are:

33234   Single lead pacemaker system, atrial or ventricular

33235   Dual lead pacemaker system

33244   Defibrillator, one or more leads

The codes for the repair of pacemaker/defibrillator electrodes are:

33218  Single electrode

33220 Dual electrodes

The codes for the insertion of right atrial or ventricular pacemaker/defibrillator lead(s) are:

33216   Single lead

33217   Two leads

The codes for the insertion of left ventricular lead (includes pocket revision) are:

s33224   Attach to existing pacemaker or defibrillator generator

+s33225 Attach at time of insertion of new pacemaker/defibrillator generator

The codes for repositioning of the lead(s) are:

33215   Reposition of right atrial or right ventricular lead

s33226  Reposition of left ventricular lead

Notes:

– Codes 33215 and 33226 include removal and replacement of the existing generator.

– Code 33215 x 2 is reported when both right atrial and right ventricular leads are repositioned.

The codes for the revision/relocation of pocket are:

33222   Pacemaker

33223   Defibrillator

Notes:

– Do not use these codes for revision of pocket during replacements to accommodate a new generator.

The codes for the insertion/replacement of temporary pacemaker lead(s) are:

33210   Single chamber lead

33211   Dual chamber leads

Notes:

– To report during a generator change, the patient must be documented as pacemaker dependent.

Pacemaker/defibrillator device evaluation codes 93279-93299 are included with codes 33206-33249 and should not be reported together. Defibrillation threshold testing (93640 Electrophysiologic evaluation of single or dual chamber pacing cardioverter-defibrillator leads including defibrillation threshold evaluation (induction of arrhythmia, evaluation of sensing and pacing for arrhythmia termination) at time of initial implantation or replacement or 93641 Electrophysiologic evaluation of single or dual chamber pacing cardioverter-defibrillator leads including defibrillation threshold evaluation (induction of arrhythmia, evaluation of sensing and pacing for arrhythmia termination) at time of initial implantation or replacement; with testing of single or dual chamber pacing cardioverter-defibrillator pulse generator) may be reported when performed with defibrillator insertion/replacement procedures.

Also this year, 71090 is deleted: Fluoroscopy is now included in 33206-33249. If no lead work is performed other than inspection with fluoroscopy, report 76000 Fluoroscopy (separate procedure), up to 1 hour physician time, other than 71023 or 71034 (eg, cardiac fluoroscopy).

Coding Example:

PROCEDURE: Dual pacemaker pulse generator exchange.

PREPROCEDURE DIAGNOSIS: Complete heart block, pacemaker battery depletion.

PROTOCOL: Via a transfemoral venous approach, a temporary pacer is placed fluoroscopically with the lead tip in the RV and activated. The left chest is prepped and draped in sterile fashion. An incision is made over the pulse generator and generator, and redundant leads are removed from the pocket. The leads are disconnected from the pulse generator tested. The lead thresholds are adequate but an insulation breach of the right ventricular lead is repaired with a kit. A new dual generator is placed and attached to the RV and RA leads. The temporary pacer is removed.

The correct coding is:

33210   Insertion or replacement of temporary transvenous single chamber cardiac electrode or pacemaker catheter (separate procedure)

33228   Removal of permanent pacemaker pulse generator with replacement of pacemaker pulse generator; dual lead system

33218   Repair of single transvenous electrode, permanent pacemaker or pacing cardioverter-defibrillator

The temporary pacer is separately coded because the patient was pacer dependent (33210). Removal of the old generator and placement of the new generator are bundled together into a single code (33228); therefore, you should not separately report 33233 Removal of permanent pacemaker pulse generator. The repair of a single lead (33218) is reported, as well. Fluoroscopy is included in all codes 33206-33249 and should not be reported separately.

dec-clearance-sale

 

David Dunn, MD, is vice president of ZHealth. He oversees physician coding and participates as an instructor for ZHealth educational programs and is a contributor to Dr. Z’s Medical Coding Series. A graduate of Texas A&M University, he completed his M.D. at the University of Texas, his surgical residency at Scott & White Hospital, and his vascular surgery fellowship at Baylor College of Medicine. A diplomat of the American Board of Surgery, Dunn is also certified in Vascular Surgery. He is a fellow of the American College of Surgeons, a member of the Southern Association for Vascular Surgery, and president-elect of AAPC’s National Advisory Board (NAB).

 

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One Response to “Rethink Pacemaker and Defibrillator Coding in 2012”

  1. Joann says:

    What code do you use for anesthesia of a temporary pacemaker?

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