Cardiology Coding Alert

Question: If the cardiologist repositions and reconnects a dislodged transvenous, right ventricular lead of a dual-chamber pacemaker or defibrillator device for one of her patients during the postoperative period, how should I report this?

Pennsylvania Subscriber

Answer: The appropriate code for repositioning is 33215 (Repositioning of previously implanted transvenous pacemaker or pacing cardioverter-defibrillator [right atrial or right ventricular] electrode).

Modifier must: Because you mention that the service was during the postoperative period, you should consider appending modifier 78 (Unplanned return to the operating/procedure room by the same physician following initial procedure for a related procedure during the postoperative period). Be sure the service meets four requirements before you append this modifier:

1. The same physician performed the original procedure (such as 33208, Insertion or replacement of permanent pacemaker with transvenous electrode[s]; atrial and ventricular) and subsequent procedure (33215,repositioning)

2. The subsequent procedure occurs within the global period of the initial procedure (for example, 33208 has a 90-day global period).

3. The subsequent procedure is a complication of the initial procedure.

4. The subsequent procedure requires a return to the operating room (OR) or procedure room.

FYI: Medicare includes cardiac cath suites in its OR definition, as indicated in Medicare Claims Processing Manual, Chapter 12, Section 40.1.B: "Treatment for postoperative complications which requires a return trip to the operating room (OR). An OR for this purpose is defined as a place of service specifically equipped and staffed for the sole purpose of performing procedures. The term includes a cardiac catheterization suite, a laser suite, and an endoscopy suite. It does not include a patient's room, a minor treatment room, a recovery room, or an intensive care unit (unless the patient's condition was so critical there would be insufficient time for transportation to an OR)" (www.cms.gov/manuals/downloads/clm104c12.pdf).