Cardiology Coding Alert

Leadless pacemaker insertion, replacement, or removal includes catheter insertion into right ventricle.

If you’ve been reporting the insertion or replacement of leadless pacemakers in your practice, you know this is the first year you’ve had a permanent codes for this services. Before 2019, you reported a Category III code. Now, you have code 33274 for the insertion or replacement of leadless pacemakers and 33275 for the removal of leadless pacemakers.

Read on to always submit clean leadless pacemaker claims in your practice.

Rely on 33274 for Insertion or Replacement of Permanent Leadless Pacemakers

If your cardiologist inserts or replaces a right ventricular permanent leadless pacemaker via a transcatheter, you should report 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).

Leadless cardiac pacemaker system defined:  A leadless pacemaker is a cylindrical device usually implanted in the endocardium (inner wall) of a ventricle that can both sense heart rate and rhythm and stimulate contractions.

A leadless pacemaker consists of a generator with a built–in battery and electrode the cardiologist inserts using a catheter with no wires to connect it to a monitor. The leadless pacemaker communicates via magnetic, ultrasound, or electrical waves for device evaluation and programming.

Example: The cardiologist makes an incision into the patient’s femoral vein and inserts a catheter up through the circulation into the right ventricle of the heart. He then inserts an initial permanent leadless pacemaker through the catheter into the ventricle. Finally, he removes the catheter.

You would report 33274 for this service.

Turn to 33275 for Permanent Leadless Pacemaker Removal

If your cardiologist performs the transcatheter removal of a right ventricular permanent leadless pacemaker, you should report 33275 (Transcatheter removal of permanent leadless pacemaker, right ventricular).

You should never report code 33275 in conjunction with code 33274, according to the CPT^® guidelines.

Don’t miss: The “insertion, replacement, or removal of a leadless pacemaker system includes insertion of a catheter into the right ventricle,” according to CPT^®.

Caution: When you look at the descriptors for codes 33274 and 33275, you will see they specify that the permanent leadless pacemaker be right ventricular.

Example: You read in the op report that the cardiologist punctures the patient’s skin over his femoral vein and inserts the dedicated, steerable retrieval catheter through an 18F sheath to remove the leadless pacemaker, which has a helix (coil). He then advances the retrieval catheter under fluoroscopic guidance to the vena cava and the right ventricle. The cardiologist positions the retrieval catheter near the leadless pacemaker, retracts the protective sleeve, and captures the cap of the leadless pacemaker with the retrieval catheter’s snare. The cardiologist closes the snare over the proximal docking feature of the pacemaker and turns it counterclockwise for two full rotations to disengage the pacemaker from the endocardium. He advances the protective sleeve over the entire device and withdraws it from the body. After removing the device, the cardiologist applies pressure over the femoral vein to control bleeding.

You would report 33275 for this service.

Follow These Tips for Clean Leadless Pacemaker Insertion and Removal

If you’re not sure of the CPT^® guidelines for 33274 and 33275, heed the following tips:

Tip 1: 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.

Tip 2: 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.

Tip 3: “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.”

Tip 4: You cannot separately report the radiological supervision and interpretation related to the leadless pacemaker because this service is included in codes 33274 and 33275.