Cardiology Coding Alert

You won't find these codes in your code book, but they were effective Jan. 1, 2015.

If your cardiologist implants a leadless cardiac pacemaker, you need to be sure you're looking in the right place for the codes - Category III.

These codes, released July 1, 2014, and implemented Jan. 1, 2015, will be published in the 2016 paper manual.

The device: "A leadless cardiac pacemaker system is a pulse generator with built-in battery and electrode for implantation in a cardiac chamber using a transfemoral catheter approach," according to CPT® Assistant, (December 2014).

In other words, the physician places the leadless pacemaker directly in the heart. There is no surgical pocket and there is no pacing lead, the thin wire that connects a traditional pacemaker generator to the heart and transmits information about the patient's heart rhythm. 

The codes involved are below:

 Insertion/replacement: 0387T, Transcatheter insertion or replacement of permanent leadless pacemaker, ventricular

• Don't report this insertion/replacement code with 0388T-0391T, which describe removal, programming, and evaluation.

• Don't report this code with +93566 (Injection procedure during cardiac catheterization including imaging supervision, interpretation, and report; for selective right ventricular or right atrial angiography [List separately in addition to code for primary procedure]) for right ventriculography in conjunction with leadless pacemaker insertion.

• Don't report this code with 76000 (Fluoroscopy ...) or 75820 (Venography, extremity ...) for imaging related to the pacemaker service.

Removal: 0388T, Transcatheter removal of permanent leadless pacemaker, ventricular

• Don't report this removal with insertion/replacement code 0387T. 

• Don't report this code with +93566 for right ventriculography in conjunction with leadless pacemaker insertion.

• Don't report this code with 76000 (Fluoroscopy ...) or 75820 (Venography, extremity ...) for imaging related to the pacemaker service.

Programming eval: 0389T, 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, leadless pacemaker system

• Don't report this programming eval code with insertion/replacement code 0387T, peri-procedural eval code 0390T, or interrogation code 0391T.

Peri-procedural eval: 0390T, Peri-procedural device evaluation (in person) and programming of device system parameters before or after a surgery, procedure or test with analysis, review and report, leadless pacemaker system 

• Don't report this peri-procedural code with insertion/replacement code 0387T, programming eval code 0389T, or interrogation code 0391T.

Interrogation: 0391T, Interrogation device evaluation (in person) with analysis, review and report, includes connection, recording and disconnection per patient encounter, leadless pacemaker system

• Don't report this interrogation code with insertion/replacement code 0387T, programming code 0389T, or peri-procedural eval code 0390T.

Cat. III reminder: As a general explanation, "once there is FDA approval, US publications describing safety, and performance of the service across multiple sites, the CPT® Editorial Panel will typically support development of a Category I code to replace the tracking Category III code," says Gregory Przybylski, MD, of JFK Medical Center, Edison, NJ. "While this change does not guarantee payment by third-party payers, it does show that the clinical use is becoming more widespread. However, the level of published evidence required by third-party payers to cover new technology is much higher than that required by the CPT® Editorial Panel to approve a Category I code."