Cardiology Coding Alert

Question: How would you code a replacement of a single-chamber pacemaker with a dual-chamber pacemaker when the original lead cannot be reused?

Steve Keiser, Carolina Heart, PA

Answer: CPT code 33214 (upgrade of implanted pacemaker system, conversion of single chamber system to dual chamber system [includes removal of previously placed pulse generator, testing of existing lead, insertion of new lead, insertion of new pulse generator]) specifically addresses the situation described in the question, says Terry Fletcher, BS, CPC, CCS-P, a cardiology coding specialist and president of Physician Reimbursement Solutions, a coding and reimbursement consulting company in Laguna Beach, CA. She adds that if the cardiologist also is using fluoroscopy, then code 71090 should be billed. (See related article on page 73.)

Fletcher notes that even if the procedure performed did not fully match the code description (in this case, it does), CPT codes may be used as long as the procedure includes 80 percent of what the code describes. For instance, when performing an upgrade, cardiologists usually replace the generator, but on occasion they do not. However, even in such circumstances, coding the procedure 33214 would usually be appropriate, and modifier -52 (reduced services) would not be required.