Wiki Cardiac Pacemaker Placement

[maine4me]

I was asked to look at documentation regarding placment of cardiac pacemakers, since there was a MLN Matters article (MM9078) with coding changes effective 7/1/15. There have been some denials.
I am not a hospital coder, rather a professional coder. What I saw in some of the records was that the V53.31 reported for end of battery life, was listed as the primary diagnosis. Based on the new guidelines, this should be the condition that requires the patient to have the pacemaker. Then the V53.31 should be listed subsequently.
Per the coding supervisor at the hospital, she said the V53.31 is a procedure code for outpatient hospital billing. Is this correct? If so, should it be listed in the diagnosis category as primary.

This does not seem right to me, but as I said I am not a hospital coder.

 

[Triachcpc]

Vickie - You are correct. V codes can be used on the professional side, as well. The facility procedure codes would be from ICD-9-CM Vol 3 (if inpatient or observation - i.e., under the 37.8X).

I think the issue here might be the required medical necessity diagnosis (es) - i.e., treatment of non-reversible symptomatic bradycardia d/t SSS or 2nd/3rd degree AV block PLUS the required -KX modifier that needs to be indicated on the CPT code.

Hope this helps..Trish

 

[coop22]

Our practice uses the 996.01 and V45.01 for pacemaker end of life. Check dictation to see if DX codes can be used. If the payer is Medicare use the KX modifier. If the pacemaker was placed within the global of another procedure make sure the 78 is also attached.