Cardiology Coding Alert

Hint: Never report 33274 in conjunction with 33275.

Pacemaker and implantable defibrillator system claims can be very challenging since CPT^® offers rather lengthy guidelines you have to follow for these services. Permanent leadless pacemakers, a specific type of pacemaker, are no exception.

Take a look at what you need to know about reporting leadless pacemakers so your claims will always stay on track.

Step 1: Report 33274 for Insertion/Replacement of Permanent Leadless Pacemakers

When your cardiologist inserts or replaces a right ventricular permanent leadless pacemaker via a transcatheter, 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). Since 33274 includes imaging guidance and testing/programming of a leadless pacemaker when performed, you cannot report these services separately.

A complete leadless cardiac pacemaker system includes a pulse generator with a built-in battery and an electrode for implantation in a cardiac chamber through a transcatheter approach, per the CPT^® guidelines. If your cardiologist removes and replaces the system during the same session, report 33274.

Don’t miss: Leadless pacemakers usually cause fewer medical complications and fewer post-implant activity restrictions for most patients, says Rebecca Sanzone, CPC, CPMA, compliance administrator at St. Vincent Medical Group/Ascension Health in Indianapolis, Indiana.

Step 2: Turn to This Code for Permanent Leadless Pacemaker Removal

When the provider uses a transcatheter to remove a right ventricular permanent leadless pacemaker, report 33275 (Transcatheter removal of permanent leadless pacemaker, right ventricular, including imaging guidance (eg, fluoroscopy, venous ultrasound, ventriculography, femoral venography), when performed). This code is for the removal of a leadless pacemaker system as a subsequent session to an insertion or replacement procedure without a replacement pacemaker re-inserted.

Tip: Never report 33275 in conjunction with 33274, according to CPT^®. As outlined in CPT^® Assistant Volume 29, Issue 3, when your physician replaces a leadless pacemaker, removing the original pacemaker is included in 33274’s code descriptor. So, you should not report the removal (33275) along with the replacement (33274).

Step 3: Use Caution When Reporting These Services Together

CPT^® has specific rules about which services you should not report along with 33274 and 33275.

Rule 1: For example, you should not report 33274 and 33275 in conjunction with right heart catheterization code 93451; combined right and left heart catheterization code 93453; or catheter placement codes 93456, 93457, 93460, and 93461. Exception: However, you are allowed to report these codes together if the cardiologist performs complete right heart catheterization for indications distinct from the leadless pacemaker procedure during the same session.

“Leadless pacemakers function similar to regular transvenous pacemakers and are delivered via a catheter in the right ventricle, which is why you would not report a right heart catheterization unless the physician performs a full diagnostic study for reasons distinct from the leadless pacemaker procedure,” says Robin Peterson, CPC, CPMA, manager of professional coding and compliance services, Pinnacle Enterprise Risk Consulting Services, LLC in Centennial, Colorado. “The leadless pacemaker system eliminates the need for pocket creation and a transvenous lead, which reduces the source of some of the complications associated with a pacemaker placement.”

Rule 2: Also, subsequent leadless pacemaker device evaluations (93279, 93286, 93288, 93294, and 93296) are included with 33274 and 33285 and should not be reported at the time of placement. After the device is placed, follow-up for device checks becomes billable.

Rule 3: Finally, the radiological supervision and interpretation related to the pacemaker procedure are included in 33274 and 33275. Additionally, fluoroscopy (76000 and +77002), ), ultrasound guidance for vascular access (+76937), right ventriculography (+93566), and femoral venography (75820) are included in codes 33274 and 33275 when your physician performs these services, so you should not report them separately.