Wiki Complicated ICD Insertion


Local Chapter Officer
Ferndale, WA
Best answers

I have a procedure note that was given to me by one of my coders and I would like to get some feedback from you before I give it back to him.

In this case, the physician successfully placed a single lead subpectoral ICD system and subsequently the patient was prepped for DFT testing. V-Fib was induced but the delivered shock was unsuccessful in cardioverting the patient so the patient was rescued with an external joule shock. On second attempt, induction was performed with the same result and patient was once again externally cardioverted. At this time a subcutaneous coil was implanted and DFT testing was now successful.

Here is the physician's modifier statement: "Because of the complexity of the DFT testing, which required four instead of the usual two DFT tests and included complex decision making regarding how to procedd after two failed DFT tests, the presence of presence of a subpectoral instead of subcutaneous pocket, and the need for implantation of a subcutaneous coil which is infrequently completed, a modifier 22 should be added to the ICD implantation and DFT testing portions of the procedure".

Two questions were raised about this case. One, should the 22 modifier be applied to both procedures or just one or the other? And, should the subcutaneous coil and cardioversions be billed , or be included in the reason for the use of modifier 22?

Thank you in advace for your feedback!

Jessica Lira, CPC
I would only apply the 22 to the cardioversion code since that is where he seems to have the problem getting the patient stable. Since the coil does not have a code (or not one I'm aware of) I'm not sure if you can bill both, and since you would have to use an unlisted code for the coil, it would not show up on CCI.

Bill both and see what happens.