Cardiology Coding Alert

Never report 33275 in conjunction with code 33274.

If you report pacemakers and implantable defibrillators in your cardiology practice, make sure you study the new rules and codes in the 2019 CPT^® manual. Although there is a lot of new information to keep track of, you don’t have to fall behind.

Read on to help keep your pacemaker claims in tip-top shape.

Focus on 33274, 33275 Rules

This year, you’ll find two new codes in the pacemaker/implantable defibrillator section of the CPT^® manual. They are as follows:

• 33274 (Transcatheter insertion or replacement of permanent leadless pacemaker, right ventricular, including imaging guidance (eg, fluoroscopy, venous ultrasound, ventriculography, femoral venography) and device evaluation (eg, interrogation or programming), when performed)
• 33275 (Transcatheter removal ofpermanentleadless pacemaker, right ventricular).

Along with these codes come the following new CPT^® guidelines you must adhere to:

• Rule 1: Don’t report code 33275 in conjunction with code 33274.
• Rule 2: When reporting the implantation of a leadless pacemaker system (leadless generator and lead), you should report 33274. Don’t miss: “Insertion, replacement, or removal of a leadless pacemaker system includes insertion of a catheter into the right ventricle,” according to the CPT^® manual.
• Rule 3: Don’t report 33274 and 33275 in conjunction with venography code 75820; fluoroscopy codes 76000 and +77002; +ultrasonic guidance code +76937; or right ventriculography code 93566.
• Rule 4: You should not report 33274 and 33275 in conjunction with right heart catheterization code 93451; combined right and left heart catheterization code 93453; catheter placement codes 93456, 93457, 93460, and 93461; or codes 93530 (Right heart catheterization, for congenital cardiac anomalies)-93533 (Combined right heart catheterization and transseptal left heart catheterization through existing septal opening, with or without retrograde left heart catheterization, for congenital cardiac anomalies). Exception: You are allowed to report these codes together if the cardiologist performs complete right heart catheterization for indications distinct from the leadless pacemaker procedure.
• Rule 5: “The subsequent leadless pacemaker device evaluations (93279, 93286, 93288, 93294, and 93296) are included within the primary surgical procedure and not reported separately,” according to Christina Neighbors, MA, CPC, CCC, Coding Quality Auditor for Conifer Health Solutions, Coding Quality & Education Department, and member of AAPC’s Certified Cardiology Coder steering committee. “However, these may be reported when performed during a different session of the primary surgical procedures.”

Leadless cardiac pacemaker system defined: A leadless cardiac pacemaker system includes “a pulse generator with built-in battery and electrode for implantation in a cardiac chamber via a transcatheter approach,” according to the CPT^® manual.

Tackle These Transvenous Electrode Removal Guidelines

The new CPT^® guidelines also clarify how you should handle situations where the cardiologist removes transvenous electrodes.

The cardiologist may first attempt to remove the transvenous electrodes via transvenous extraction — codes 33234 (Removal of transvenous pacemaker electrode(s); single lead system, atrial or ventricular); 33235 (Removal of transvenous pacemaker electrode(s); dual lead system); or 33244 (Removal of single or dual chamber implantable defibrillator electrode(s); by transvenous extraction).

In cases where this transvenous extraction is unsuccessful, the cardiologist may then perform a thoracotomy (codes 33238 (Removal of permanent transvenous electrode(s) by thoracotomy) or 33243 (Removal of single or dual chamber implantable defibrillator electrode(s); by thoracotomy)) to remove the electrodes. If appropriate, you should submit insertion codes 33212, 33213, 33221, 33230, 33231, 33240 in addition to thoracotomy or endoscopic epicardial lead placement codes (33202 or 33203) to report the generator insertion, if the same physician performs the service during the same session.

Additionally, you can separately report the removal of a subcutaneous implantable defibrillator electrode with code 33272 (Removal of subcutaneous implantable defibrillator electrode). If you need to report the removal and replacement of a leadless pacemaker system during the same session, submit code 33274. And, if you are reporting the removal of a leadless pacemaker system without replacement, submit 33275.

Observe New Device Evaluation Clarification

The CPT^® guidelines also explain how to appropriately report the following device evaluation codes:

• 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)
• 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)
• 93279 (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; single lead pacemaker system or leadless pacemaker system in one cardiac chamber)-93299 (Interrogation device evaluation(s), (remote) up to 30 days; implantable cardiovascular physiologic monitor system or subcutaneous cardiac rhythm monitor system, remote data acquisition(s), receipt of transmissions and technician review, technical support and distribution of results).

Don’t miss: You cannot report codes 93260, 93261, or 93279-93299 in conjunction with pulse generator and lead insertion or revision codes 33206-33249; 33262-33264; or 33270-33273.

Additionally, you cannot report device evaluation codes 93279, 93286, 93288, 93294, or 93296 in conjunction with leadless pacemaker insertion and removal codes 33274 or 33275.

Hone in on 3 Rules for Reporting DFT

Check out what the new CPT^® guidelines have to say about defibrillator threshold testing (DFT).

Rule 1: You can separately report DFT during transvenous implantable defibrillator insertion (33249) or replacement (33262-33264) with codes 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 (… with testing of single or dual chamber pacing cardioverter-defibrillator pulse generator), Neighbors explains.

Rule 2: It is not appropriate to separately report DFT testing during subcutaneous implantable defibrillator system insertion (33270).

Rule 3: You can separately report DFT testing for transvenous or subcutaneous implantable defibrillator in follow-up (DFT test not at time of implant) or at the time of replacement with codes 93642 (Electrophysiologic evaluation of single or dual chamber transvenous pacing cardioverter-defibrillator (includes defibrillation threshold evaluation, induction of arrhythmia, evaluation of sensing and pacing for arrhythmia termination, and programming or reprogramming of sensing or therapeutic parameters)) or 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)).