Cardiology Coding Alert

Question: The cardiologist makes an incision into the patient’s femoral vein and inserts a catheter up through the circulation into the right ventricle of the heart. He then inserts an initial permanent leadless pacemaker through the catheter into the ventricle. Finally, he removes the catheter. Which CPT^® code should we report for this scenario?

Florida Subscriber

Answer: You would report 33274 (Transcatheter insertion or replacement of permanent leadless pacemaker, right ventricular, including imaging guidance (eg, fluoroscopy, venous ultrasound, ventriculography, femoral venography) and device evaluation (eg, interrogation or programming), when performed) for this service. Insertion, replacement, or removal of a leadless pacemaker system includes insertion of a catheter into the right ventricle, according to the CPT^® manual.

Caution: You should never report code 33274 in conjunction with code 33275 (Transcatheter removal of permanent leadless pacemaker, right ventricular).

Leadless cardiac pacemaker system defined: A leadless pacemaker is a cylindrical device usually implanted in the endocardium (inner wall) of a ventricle that can both sense heart rate and rhythm and stimulate contractions.

A leadless pacemaker consists of a generator with a built–in battery and electrode the cardiologist inserts using a catheter with no wires to connect it to a monitor. The leadless pacemaker communicates via magnetic, ultrasound, or electrical waves for device evaluation and programming.