Cardiology Coding Alert

When the national policy doesn’t define applicable codes, your local policy may be able to help.

Do you know where to find frequency guidelines on pacemaker clinic services such as programming and interrogation evaluations?

Pacemaker clinic services get a mention in Section 20.8.1.1, Transtelephonic Monitoring of Cardiac Pacemakers, in the Medicare National Coverage Determination (NCD) Manual (www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/Downloads/ncd103c1_Part1.pdf).

In general, the frequency of pacemaker clinic services is the decision of the patient’s physician, taking into account the medical condition of the patient, says Mary I. Falbo, MBA, CPC, president and CEO of Millennium Healthcare Consulting Inc., citing the NCD.

For clinic services, “The following monitoring guidelines apply to lithium battery pacemakers (all pacemakers currently have lithium batteries),” Falbo says:

• Single-chamber pacemakers: Twice in the first six months following implant, then once every 12 months
• Dual-chamber pacemakers: Twice in the first six months, then once every six months.

Tip: Intervening potential complications, such as otherwise unexplained syncope, could warrant additional, more frequent attention, Falbo says. You may see guidance like this in LCDs, so remember to check for local policies, which may list the specific codes involved, such as:

• 93279-93281, Programming device evaluation (in person) with iterative adjustment …
• 93288, Interrogation device evaluation (in person) …
• 93724, Electronic analysis of antitachycardia pacemaker system …

Track it: The practice should ensure that it meets the frequency parameters by tracking these services in the EMR, Falbo advises.

Ace ICD-10-CM Coding for Pacemaker Encounters

ICD-10-CM offers two encounter codes for cardiac pacemaker adjustment and management:

• Z45.010, Encounter for checking and testing of cardiac pacemaker pulse generator [battery] 
• Z45.018, Encounter for adjustment and management of other part of cardiac pacemaker.

Watch out: If the patient has an ICD with a synchronous cardiac pacemaker, you should not use one of the above codes. Instead, report Z45.02 (Encounter for adjustment and management of automatic implantable cardiac defibrillator). That code has a note showing that it includes “Encounter for adjustment and management of automatic implantable cardiac defibrillator with synchronous cardiac pacemaker.”

Bonus tip: Remember the transtelephonic services described in this issue in “Reconcile CMS Frequency Guidelines With CPT^® Reporting Guidelines to Avoid 93293 Mistakes”? Clinic services involve more than a simple in-person version of transtelephonic monitoring.

The in-person version of 93293 (Transtelephonic rhythm strip pacemaker evaluation[s] single, dual, or multiple lead pacemaker system …) would be 93040-93042 (Rhythm ECG, 1-3 leads …).