Cardiology Coding Alert

Although CPT 2002 includes more than a dozen codes related to pacemaker implantation, replacement and removal, the coding process for these procedures can be made simpler with information on the type of pacemaker (single or dual chamber), the components (pulse generators or electrodes/leads) and the number of days that have passed since the initial implantation.
 
"You need good communication from the physician to determine these factors," says Rebecca Sanzone, CPC, billing manager with Mid-Atlantic Cardiovascular Associates, a 58-physician practice in Baltimore. "That means the cardiologist must let the coder know exactly what was done." From that information, she adds, the coder may still have to pick and choose among codes, because many pacemaker codes are components of other codes and may be included in a more comprehensive procedure.
 
Sanzone advises coders to ask cardiologists the following questions to make the process even simpler:
  Was the procedure a revision or removal?
  When was the original implantation?
  What revisions were made?
  Was anything done to the pocket?
  What approach did the physician use? 
Removal, Insertion and Repair
CPT 2002 covers procedures involving the components of a pacemaker, such as the pulse generator and electrodes (also referred to as leads), as well as the entire pacemaker itself.
 
Pulse Generators. Removing and replacing pulse generators are the simplest of these procedures:
 
Use 33233 (Removal of permanent pacemaker pulse generator) when a generator is removed.
 
Use 33233 and either 33212 (Insertion or replacement of pacemaker pulse generator only; single chamber, atrial or ventricular) or 33213 ( dual chamber) when a generator is replaced.
 
Note: The "replacement" procedure noted in 33212 and 33213 does not cover removal of an old generator but merely the insertion of a new generator, which is why the removal code (33233) should be billed with the replacement code.
 
Electrodes/Leads. Electrodes/leads are considerably more difficult to remove, insert, reposition, replace and repair than generators because they are placed on the heart chamber walls rather than in a pocket away from the heart.
 
To report removal only, use 33234 (Removal of transvenous pacemaker electrode[s]; single lead system, atrial or ventricular) or 33235 ( dual lead system).
 
To report insertion, repositioning or replacement, use 33216 (Insertion or repositioning of a transvenous electrode [15 days or more after initial insertion]; single chamber [one electrode] permanent pacemaker or single chamber pacing cardioverter-defibrillator) or 33217 ( dual chamber [two electrodes] permanent pacemaker or dual chamber pacing cardioverter-defibrillator).
 
To report repair (as opposed to replacement), use 33218 (Repair of single transvenous electrode for a single chamber, permanent pacemaker or single chamber pacing cardioverter-defibrillator) or 33220 (Repair of two transvenous electrodes for a dual chamber permanent pacemaker or dual chamber pacing cardioverter-defibrillator).
 
Entire Pacemaker. CPT includes codes that are used when the entire pacemaker (generator and [...]