Cardiology Coding Alert

Question: Can we bill 33233 (Removal of permanent pacemaker pulse generator) and 33222 (Revision or relocation of skin pocket for pacemaker) at the same time?I billed 33207 (Insertion or replacement of permanent pacemaker with transvenous electrode[s]; ventricular), 71090 (Insertion pacemaker, fluoroscopy and radiography, radiological supervision and interpretation),33233 and 33222. All were paid but 33222. Do you know why we weren't paid for 33222? What should I do to correct this? Texas Subscriber Answer: Pocket revision (33222) is a bundled component of the pacemaker pulse generator code (33233) and a bundled component of the single-chamber pacemaker generator insertion code (33212). Both of these edits have a "0" indicator under the Correct Coding Initiative, which means that no modifier will bypass the edit. This is why the carrier denied your claim and why carriers will deny future claims that violate these edits, no matter how you submit the initial claim. Some cardiology practices have had success with these denials on appeal. The approach that has worked in some cases is to explain fully the reason for the pocket revision. In some cases, the size of the generator being removed is significantly different from the size of the implanted generator. You could attach to your appeal pictures illustrating the size variance between the two generators and possibly dimensions to help illustrate the pocket-revision necessity. This data is available from the device manufacturer.