Cardiology Coding Alert

Question: How should I code this? The cardiologist replaced a dual-lead pacemaker generator for end of life, but he also replaced the malfunctioning right atrial lead at the same time.

Pennsylvania Subscriber

Answer: You should report the different steps separately using these codes:

• 33233, Removal of permanent pacemaker pulse generator only

• 33235, Removal of transvenous pacemaker electrode(s); dual lead system

• 33206, Insertion of new or replacement of permanent pacemaker with transvenous electrode(s); atrial.

Rationale: A table in the CPT^® guidelines indicates the following are the proper codes for removal and replacement of a pacemaker pulse generator and transvenous electrodes: 33233 for generator removal + (33234 or 33235 for electrode removal) + (33206, 33207, or 33208 for system insertion or replacement) and, when appropriate, +33225 (Insertion of pacing electrode, cardiac venous system, for left ventricular pacing, at time of insertion of implantable defibrillator or pacemaker pulse generator [e.g., for upgrade to dual chamber system] [List separately in addition to code for primary procedure]).

You don’t use +33225 for your case because +33225 is specific to a left ventricular electrode, which does not apply to this patient.

Note that another code you don’t see in the list is 33214 (Upgrade of implanted pacemaker system, conversion of single chamber system to dual chamber system [includes removal of previously placed pulse generator, testing of existing lead, insertion of new lead, insertion of new pulse generator]). Code 33214 is for converting a single chamber system to a dual chamber system. In your case, the patient already had a dual-lead system, so this is not a conversion procedure.

Caution: If the cardiologist left the existing atrial lead in place and simply capped it, you should not report removal code 33235.

Diagnosis codes: For the diagnosis codes, you should link V53.31 (Fitting and adjustment of cardiac pacemaker) to generator removal code 33233 to indicate battery end of life. Under ICD-10-CM, you’ll use Z45.010 (Encounter for checking and testing of cardiac pacemaker pulse generator [battery]), which applies to replacing the battery according to a note with the code.

Use 996.01 (Mechanical complication due to cardiac pacemaker [electrode]) or, in ICD-10, T82.110A (Breakdown [mechanical] of cardiac electrode, initial encounter) for the electrode removal.

Both the adjustment and complication codes apply to replacement code 33206. Depending on payer policy, you also may need to report the code for the condition that necessitates the pacemaker.