Cardiology Coding Alert

Question: The cardiologist performed a face-to-face evaluation, and then he optimally adjusted the existing parameters of an already implanted dual lead pacemaker system. He changed various operating functions of the system that sense and regulate the heart’s rhythm within the two heart chambers. Which CPT^® code should we report for this service?

Maine Subscriber

Answer: You should report 93280 (Programming device evaluation (in person) with iterative adjustment of the implantable device to test the function of the device and select optimal permanent programmed values with analysis, review and report by a physician or other qualified health care professional; dual lead pacemaker system) for this service. Code 93280 represents both the professional and technical components of this service. Never report 93280 during an operative encounter because it is included within the operative primary procedure, says 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.

Caution: You should never report 93280 in conjunction with 93286 (Peri-procedural device evaluation (in person) and programming of device system parameters before or after a surgery, procedure, or test with analysis, review and report by a physician or other qualified health care professional; single, dual, or multiple lead pacemaker system, or leadless pacemaker system) or 93288 (Interrogation device evaluation (in person) with analysis, review and report by a physician or other qualified health care professional, includes connection, recording and disconnection per patient encounter; single, dual, or multiple lead pacemaker system, or leadless pacemaker system), according to CPT^®.

Be cautious reporting 93286 because a sentence stating “peri-procedural device evaluation in person and programming of device system parameters before or after a surgery” is not enough supporting documentation, Neighbors says. A separate report and/or paragraph within the operative report providing required specificity is needed. The system/lead(s) optimal parameter values/functions must be documented.