New Medicare Coverage for Pacemakers Used to Treat Bradycardia
If your practice sees patients with documented nonreversible symptomatic bradycardia, you should know that the Centers for Medicare & Medicaid Services (CMS) recently established a national coverage determination (NCD) allowing payment for implanted permanent cardiac single- or dual-chamber pacemakers, used for the treatment of this disease.
Coverage is effective for claims with dates of service on or after Aug. 13, 2013. Note, however, that Medicare contractors have until July 7, 2014 to implement this NCD. Claims for implanted permanent cardiac pacemakers submitted before July 7 may be denied, and claims may need to be resubmitted.
UPDATE: CMS released MM8525 Revised July 10, 2014, delaying implementation until further notice.
Payment for implanted permanent cardiac pacemakers is contingent on documentation of nonreversible symptomatic bradycardia due to:
- Sinus node dysfunction
- Second- or third-degree atrioventricular block
Append modifier KX to the procedure code to indicate that documentation is on file verifying the patient has non-reversible symptomatic bradycardia (ICD-9: 427.89 Other specified cardiac dysrhythmias; ICD-10 Bradycardia, unspecified).
The telltale sign of bradycardia is a heart rate less than 60 beats per minute, which may cause one or more of the following symptoms:
- Syncope (780.2)
- Seizures (780.3)
- Congestive heart failure (482.0)
- Dizziness (780.4)
- Confusion (298.2)
For proper code selection, documentation must indicate whether the right atrium or right ventricle was targeted (single-chamber pacemaker), or both (dual-chamber pacemaker).
33206 Insertion of new or replacement permanent pacemaker with transvenous electrode; atrial
33207 ; ventricular
33208 ; atrial and ventricular
Local anesthesia (CPT® 00530 Anesthesia for permanent transvenous pacemaker insertion) is generally used to perform the inpatient procedure.
For complete details, see Medicare NCD Manual, chapter 1, part 1, sec. 20.8.3.
Source: CMS transmittal 161, CR 8528, Feb. 6, 2013