Cardiology Coding Alert

You Be the Coder :

Indicate Code for New Lead Insertion

Question: Our doctor indicated the following on his op note: replacement of dual-chamber pacemaker generator, insertion of a new left ventricular lead, subclavian venogram, intraoperative fluoroscopic supervision. Which codes should I report?

New Hampshire Subscriber

Answer: For replacing the dual-chamberpacemaker generator, you should report 33233 (Removal of permanent pacemaker pulse generator) and 33213 (Insertion or replacement of pacemaker pulse generator only; dual chamber). CPT guidelines state that you should report both removal and replacement codes for this service.

Inserting a new left ventricular lead, in addition to the existing right atrial and right ventricular leads,merits +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] [List separately in addition to code for primary procedure]).

RS&I: Payers include venography in the electrode insertion, but you may report the fluoroscopy separately using 71090-26 (Insertion pacemaker, fluoroscopy and radiography, radiological supervision and interpretation; Professional component).