Cardiology Coding Alert

Prepare to distinguish between pacemaker battery and other parts.

ICD-10 will require you to be a little more specific about coding pacemaker adjustment encounters, but you should have an easier transition to coding automatic implantable cardiac defibrillator (AICD) encounters.

ICD-9-CM Codes:

• V53.31, Fitting and adjustment of cardiac pacemaker
• V53.32, Fitting and adjustment of automatic implantable cardiac defibrillator
• V53.39, Fitting and adjustment of other cardiac device

ICD-10-CM Codes:

• 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
• Z45.02, Encounter for adjustment and management of automatic implantable cardiac defibrillator
• Z45.09, Encounter for adjustment and management of other cardiac device

The codes above apply to encounters where the physician fits, adjusts, removes, replaces, or reprograms a cardiac device.

ICD-9 coding rules: The V53.3x codes apply to removal and replacement of devices, as well as reprogramming, but they are not appropriate if you are indicating only status without need for care (in that case, use ICD-9 code V45.0x, Cardiac device in situ). You should not use V53.31 to indicate mechanical complication; instead use 996.01 (Mechanical complication due to cardiac pacemaker [electrode]).

Remember that if the patient has an AICD with synchronous cardiac pacemaker, you should look to V53.32 rather than V53.31 for fitting and adjustment encounters.» » » » » » »

ICD-10 changes: Under ICD-10, you’ll have to choose between two codes for pacemaker services: Z45.010 for the pulse generator and Z45.018 for any other part. You’ll still have one code for AICD services (Z45.02) and one related to other devices (Z45.09).

The includes and excludes notes accompanying the ICD-10 codes are similar to those for the ICD-9 codes. A note with Z45.010 tells you it is appropriate for replacing a pacemaker pulse generator. A note with Z45.02 explains you should use that code when the patient has an encounter for adjustment and management of an AICD with synchronous cardiac pacemaker.

Notes for the entire Z45.- range indicate the codes apply to removal or replacement of an implanted device. However, you should look elsewhere to code malfunction or other complications of a device (see T82.1-, Mechanical complication of cardiac electronic device) or the simple presence of a device (see Z95.-, Presence of cardiac and vascular implants and grafts).

Documentation: Your provider’s documentation should not need to change for you to find the proper code under ICD-10, as long as he is clear about which device and which part of a pacemaker is being serviced. For more efficient coding, make distinguishing between services related to pacemaker batteries and services related to other pacemaker parts easy on yourself. For example, you could list both codes on the superbill, or list Z45.01- and have the provider mark or circle "pulse gen" or "other."

Coder tips: You may have noticed the ICD-10 codes started with the letter Z. ICD-10’s Z codes essentially replace ICD-9’s V codes, according to Lynn M. Anderanin, CPC, CPC-I, COSC, in her "ICD-10-CM 101" presentation for AudioEducator.com.

Remember: CMS has finalized the ICD-10 compliance date of Oct. 1, 2014. When ICD-10 is implemented, you should apply the code set and official guidelines in effect for the date of service reported. Learn more at www.cms.gov/ICD10/ and www.cdc.gov/nchs/icd/icd10cm.htm#10update.