33285/33286

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Cardiac event recorder procedure changes
CPT Assistant, April 2019 Page: 3 Category:

Coding Changes to Cardiac Event Recorder Procedures

Important changes were made in the Subcutaneous Cardiac Rhythm Monitor subsection of the Cardiovascular System of the Current Procedural Terminology (CPT®) 2019 code set to address the advances made in technology for subcutaneous cardiac event rhythm monitors. Two codes (33282, 33284) were deleted and replaced by two new codes to report the insertion (33285) and the removal (33286) of a subcutaneous cardiac rhythm monitor, and new guidelines and parenthetical notes instructing users of the appropriate codes to report were added. This article provides an overview of these changes.

Subcutaneous Cardiac Rhythm Monitor

33285 Insertion, subcutaneous cardiac rhythm monitor, including programming
33286 Removal, subcutaneous cardiac rhythm monitor
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(Initial insertion includes programming. For subsequent electronic analysis and/or reprogramming, see 93285, 93291, 93298, 93299)
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Technological advances made over the last decade for subcutaneous cardiac event rhythm monitors have resulted in smaller devices with more features. As a result, the use of older and larger monitor devices has steadily decreased to a low enough volume to warrant coding changes. While codes 33285 and 33286 refer to subcutaneous continuous cardiac rhythm monitors, these codes are also applicable for reporting implant and explant services associated with older implantable/insertable loop recorder (ILR) devices where medically appropriate. Code 33285 describes the subcutaneous insertion of a cardiac rhythm monitor, including the requisite programming. Code 33286 describes the complete removal of the monitor.

Subcutaneous cardiac rhythm monitors are used for long-term continuous cardiac monitoring in patients previously undiagnosed but suspected to be at high-risk for atrial fibrillation (AF) and stroke. AF is a common cardiac condition in which the heart beats irregularly or rapidly.1 Patients with AF are at risk of stroke because of small blood clots that may form in the heart and subsequently travel to the brain.

The following clinical examples and procedural descriptions reflect typical clinical scenarios for which these new codes would be appropriately reported.

Clinical Example (33285)

A 42-year-old female presents with a history of syncopal spells with inconclusive results using various investigations. The patient continues to have distressing symptoms every three to four months. A history and physical examination were performed. She was referred for insertion of a subcutaneous cardiac rhythm monitor.

Description of Procedure (33285)

Using blunt dissection, create a subcutaneous pocket the size and shape of the cardiac rhythm monitor using a specifically designed insertion tool or surgical instrument. Maintain hemostasis using standard techniques. Then insert the cardiac rhythm monitor into the pocket with an insertion tool or manually. Verify the ECG signal quality and amplitude by placing the programmer head in a sterile sleeve over the device, establishing telemetry. Evaluate the waveform on the programmer screen and adjust the gain to optimize waveform amplitude. Then close the incision with adhesive strips, surgical glue, staples, or subcuticular absorbable sutures, as needed. Dress the wound, program the cardiac rhythm monitor using a pacemaker programmer, and initiate recording.

Clinical Example (33286)

A 44-year-old female presents with a history of syncopal spells, the cause of which was recently diagnosed using a subcutaneous cardiac rhythm monitor. A history and physical examination were performed. The procedure, indications, potential complications, and alternatives were explained to the patient who appeared to understand and indicated the same. An opportunity for questions was provided and informed consent obtained.

Description of Procedure (33286)

Make a 1- to 2-cm incision through the previous implant incision. The operator tunnels under the skin to locate the device which typically migrates significantly from the site of original implant. Once located, debride extensive adhesions to free the device for removal. Cut any sutures anchoring the recorder to the subcutaneous tissue and remove the device from the pocket. Achieve hemostasis of the pocket and tunnel. Flush the pocket and tunnel and close with adhesive strips, surgical glue, staples, or subcuticular sutures as needed. Dress the wound.

References

1. Chugh S, Havmoeller R, Narayanan K, et al. Worldwide Epidemiology of Atrial Fibrillation: A Global Burden of Disease 2010 Study. Circulation. 2013;129(8):837-847. https://www.ahajournals.org/doi/full/10.1161/CIRCULATIONAHA.113.005119. Accessed March 18, 2019.
 
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