Cardiology Coding Alert

Question: The cardiologist documented testing pacemaker leads using fluoroscopy (71090) in the hospital. Which code is appropriate for the testing?

New Hampshire Subscriber

Answer: You mention 71090 (Insertion pacemaker, fluoroscopy and radiography, radiological supervision and interpretation), which is specific to radiological supervision and interpretation at the time of device insertion. So presumably the cardiologist was testing the leads at the time the patient first received the pacemaker.

You can't report lead evaluation separately at the time of pacemaker insertion (such as 33206-33208).

Verify device: Doctors sometimes document "pacer" when referring to a pacing automatic internal cardioverter defibrillator (AICD), so confirm which device the cardiologist is referring to. You may report one of the following two codes for evaluating leads at the time of an AICD insertion:

• 93640-26 -- Electrophysiologic evaluation of single or dual chamber pacing cardioverter-defibrillator leads including defibrillation threshold evaluation (induction of arrhythmia, evaluation of sensing and pacing for arrhythmia termination) at time of initial implantation or replacement; Professional component.

• 93641-26 -- ... with testing of single or dual chamber pacing cardioverter-defibrillator pulse generator.

Code 93640 is appropriate when your cardiologist performs the EP AICD lead evaluation before he connects them to the pulse generator. This is rare.

In contrast, 93641 is much more common and represents the cardiologist testing the entire system once he connects the pulse generator. It requires induction of ventricular tachycardia/fibrillation to assess the system's defibrillation capabilities. So you would not report 93641 for just testing the lead for pacing thresholds and sensitivity.