Cardiology Coding Alert

Question: My cardiologist took out an old dual-chamber pacemaker generator, replaced it with a new biventricular pacemaker generator, and added a left ventricular lead. How should I code this? Oregon Subscriber Answer: You should start by billing 33233 (Removal of permanent pacemaker pulse generator) and 33213 (Insertion or replacement of pacemaker pulse generator only; dual chamber) to represent the physician's work removing the old pacemaker generator and inserting the new dual-chamber pacemaker generator.

You should also report +33225 (Insertion of pacing electrode, cardiac venous system, for left ventricular pacing, at time of insertion of pacing cardioverter-defibrillator or pacemaker pulse generator [including upgrade to dual-chamber system]) because the doctor implants the new left ventricular lead and attaches it to a new generator. If the physician also documents fluoro-scopic guidance in the operative report, you should report 71090-26 (Insertion pacemaker, fluoroscopy and radiography, radiological supervision and interpretation; professional component).

Note: Coronary sinus angiography (including coronary sinus catheterization, venous occlusion, contrast injection, and the related radiological supervision and interpretation) is not separately billable.