Cardiology Coding Alert

Don’t miss how system insertion/replacement coding changes in the new year.

You’ll have new Category I codes for subcutaneous implantable defibrillator (S-ICD) services when CPT® 2015 goes into effect on Jan. 1, 2015. The Cat. I codes are similar to the Cat. III options available in 2014, but there are some key differences you’ll need to watch.

Start Here for an S-ICD and Code Crosswalk Overview

S-ICD explained: An S-ICD has a pulse generator and an electrode. The physician implants the pulse generator under the patient’s skin, typically under the armpit on the side of the chest. The physician implants the electrode so that this component attaches to the generator and extends under the skin to the target site, usually reaching from the generator and along the rib until the component reaches the breastbone. The S-ICD works by detecting the patient’s heart rhythms and delivering an electric shock (defibrillation) to correct abnormal heart rhythms. 

2014 to 2015 crosswalk: CPT® 2015 includes a crosswalk instruction that in place of 2014 Category III codes 0319T-0328T for S-ICDs, you’ll use Category I codes 33240, 33241, 33262, 33270-33273, 93260, 93261, and 93644. 

Having Cat. I codes for S-ICDs should make it easier to report these procedures and remove a lot of confusion, notes Kristine Leseman, CPC, CCC, Revenue Integrity Specialist II for a hospital in Tacoma, Wash. Having Cat. I codes rather than Cat. III codes may also make reimbursement for these services more likely, she adds.

Here’s a closer look at how you’ll apply these codes.

Apply 3 Existing Pulse Generator Codes to S-ICDs in 2015

The first three Cat. I codes in the 2015 crosswalk instruction are 33240, 33241, and 33262. 

2015: These three codes existed in 2014, but CPT® 2015 revises the descriptors by deleting “pacing cardioverter-” from in front of defibrillator and by adding “implantable” to the definitions. Below are the 2015 definitions:

• Insertion: 33240, Insertion of implantable defibrillator pulse generator only; with existing single lead
  
• Removal: 33241, Removal of implantable defibrillator pulse generator only
  
• Replacement: 33262, Removal of implantable defibrillator pulse generator with replacement of implantable defibrillator pulse generator; single lead system.
  

In 2015, you’ll continue to apply 33240, 33241, and 33262 to insertion, removal, and replacement services for pulse generators that attach to transvenous leads, just as you did in 2014. But you’ll also apply these codes to pulse generator services for generators that attach to subcutaneous electrodes. Also note that the crosswalk includes 33240 and 33262, which are specific to single lead systems. S-ICDs connect to a single electrode that the physician places under the skin.

2014: In 2014, you used Category III codes for the generator services when related to an S-ICD. CPT® 2015 deletes these codes:

• Insertion: 0321T, Insertion of subcutaneous implantable defibrillator pulse generator only with existing subcutaneous electrode
  
• Removal: 0322T, Removal of subcutaneous implantable defibrillator pulse generator only
  
• Replacement: 0323T, Removal of subcutaneous implantable defibrillator pulse generator with replacement of subcutaneous implantable defibrillator pulse generator only.
  

Include EP Evaluation in Insertion/Replacement in 2015

The next code in the 2015 crosswalk is new code 33270, which covers multiple services:

• 33270, Insertion or replacement of permanent subcutaneous implantable defibrillator system, with subcutaneous electrode, including defibrillation threshold evaluation, induction of arrhythmia, evaluation of sensing for arrhythmia termination, and programming or reprogramming of sensing or therapeutic parameters, when performed.

You’ll use 33270 when the physician inserts or replaces the complete system, including the electrode, at the same session. The code also includes defibrillation threshold evaluation, arrhythmia induction, sensing evaluation, and programming or reprogramming when the physician performs those services at the same session as the insertion or replacement.

2014: New code 33270 replaces the following codes, which CPT® 2015 deletes:

• 0319T, Insertion or replacement of subcutaneous implantable defibrillator system with subcutaneous electrode
  
• 0326T, Electrophysiologic evaluation of subcutaneous implantable defibrillator (includes defibrillation threshold evaluation, induction of arrhythmia, evaluation of sensing for arrhythmia termination, and programming or reprogramming of sensing or therapeutic parameters).
  

Key pointer: In 2014, you used one code for system insertion/replacement and another code for the electrophysiologic (EP) evaluation performed at the same session. In 2015, single code 33270 covers both the insertion/replacement and the EP evaluation. Terms you may see related to the EP evaluation include threshold testing and DFT testing, which stands for defibrillation threshold testing.

Need to Code Only an Electrode Service? See 33270-33273

The next group of codes in the 2015 crosswalk is 33270-33273. These codes apply when the physician inserts, removes, or repositions only the S-ICD electrode:

• Insertion: 33271, Insertion of subcutaneous implantable defibrillator electrode
  
• Removal: 33272, Removal of subcutaneous implantable defibrillator electrode
• Repositioning: 33273, Repositioning of previously implanted subcutaneous implantable defibrillator electrode.

Codes 33271-33273 cross almost exactly to the 2014 codes you used, which CPT® 2015 deletes, although the 2014 repositioning code applied to both electrode and generator repositioning:

• Insertion: 0320T, Insertion of subcutaneous defibrillator electrode
• Removal: 0324T, Removal of subcutaneous defibrillator electrode
  
• Repositioning: 0325T, Repositioning of subcutaneous implantable defibrillator electrode and/or pulse generator.

Turn to 93xxx Codes for Evaluation Options

The final three codes in the 2015 crosswalk will be in the Medicine section of CPT®, unlike the previous codes, which will appear in the Surgery section.

Programming: In 2015, you’ll use the following code for in-person S-ICD programming device evaluation:

• 93260, Programming device evaluation (in person) with iterative adjustment of the implantable device to test the function of the device and select optimal permanent programmed values with analysis, review and report by a physician or other qualified health care professional; implantable subcutaneous lead defibrillator system.

Code 93620 clarifies that it includes “review and report by a physician or other qualified health care professional.” This phrase wasn’t present in the 2014 code it replaces, 0328T (Programming device evaluation [in person] with iterative adjustment of the implantable device to test the function of the device and select optimal permanent programmed values with analysis, implantable subcutaneous lead defibrillator system).

Interrogation: In 2015, you’ll use 93621 for in-person S-ICD interrogation device evaluation:

• 93261, Interrogation device evaluation (in person) with analysis, review and report by a physician or other qualified health care professional, includes connection, recording and disconnection per patient encounter; implantable subcutaneous lead defibrillator system.

Code 93261 adds “by a physician or other qualified health care professional,” but otherwise has the same descriptor as the code it replaces, 0327T (Interrogation device evaluation [in person] with analysis, review and report, includes connection, recording and disconnection per patient encounter, implantable subcutaneous lead defibrillator system).

Electrophysiologic: In 2015, you’ll use 93644 for S-ICD EP evaluation performed at a different session than implant/replacement:

• 93644, Electrophysiologic evaluation of subcutaneous implantable defibrillator (includes defibrillation threshold evaluation, induction of arrhythmia, evaluation of sensing for arrhythmia termination, and programming or reprogramming of sensing or therapeutic parameters).

Code 93644 replaces 0326T (Electrophysiologic evaluation of subcutaneous implantable defibrillator [includes defibrillation threshold evaluation, induction of arrhythmia, evaluation of sensing for arrhythmia termination, and programming or reprogramming of sensing or therapeutic parameters]).

Keep in mind: The descriptors for 93644 and 0326T are the same, but you will not use them in the same way. An instruction for 2014 code 0326T told you to report it “separately during device insertion, replacement, or for follow-up device testing, when performed.” But in 2015, the code for system insertion/replacement, 33270, includes the EP evaluation. So you should not use 93644 for evaluation at the insertion/replacement session.