Cardiology Coding Alert

Question: How do the 2010 changes to electrode repositioning codes affect our coding?

Florida Subscriber

Answer: The main difference between the 2009 and 2010 descriptors for 33216, 33217, and 33223 is that the new descriptors don't reference the number of chambers.

33216, 33217: Code descriptors for 33216 and 33217 now focus on the number of electrodes rather than the device type.

The 2009 code descriptors were as follows:

• 33216 -- Insertion of a transvenous electrode; single chamber (one electrode) permanent pacemaker or single chamber pacing cardioverter-defibrillator

• 33217 -- Insertion of a transvenous electrode; dual chamber (two electrodes) permanent pacemaker or dual chamber pacing cardioverter-defibrillator. But in 2010, CPT eliminates the single and dual chamber references:

• 33216 -- Insertion of a single transvenous electrode, permanent pacemaker or cardioverter-defibrillator

• 33217 -- Insertion of 2 transvenous electrodes, permanent pacemaker or cardioverter-defibrillator.

Benefit: You may have struggled in the past with what to code when the cardiologist replaced one electrode in a dual chamber system. In 2009, 33216 represented "one electrode" but also specified "single chamber." Code 33217, on the other hand, stated "dual chamber" but also "two electrodes." Although experts have long recommended coding based on the number of electrodes (33216 for one electrode, for example), the 2010 wording makes it clear that coding based on the electrode number is the correct choice.

33223: CPT's adjustment of 33223 eliminates the phrase "single or dual chamber" because the skin pocket revision may be for a single, dual, or multiple lead device, according to CPT Changes 2010: An Insider's View:

• 2009: 33223 -- Revision of skin pocket for single or dual chamber pacing cardioverter-defibrillator

• 2010: 33223 -- Revision of skin pocket for cardioverter-defibrillator.