Help, getting edits with 33264 and 33225 (upgrade to Bi-V)

slicksurfer

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We coded with 33264 and 33225 as it was an upgrade from a dual lead ICD to a Bi-V ICD system in which MD removed and replaced the generator and added an LV pacing lead. We are getting an edit(CR7668) when billing these two codes together.

MLN Matters® Number: MM7668 Related Change Request Number: 7668 Page 3 of 3
o Modify the logic such that if procedure codes 33249 and 33225 are submitted on the same date of service:
Assign 33249 to standard APC for payment, package 33225 (change SI to N); and
Ignore FB or FC modifier on 33225 if the SI has been changed to N;
o Change SI for 33249 to T; change SI for 33225 to T when it is not submitted with 33249 on the same day.
o Add new edit 84 – Claim lacks required primary code (Return to Provider RTP)).
Criteria: Add-on code 33225 is submitted without one of the following primary codes on the same day: 33206, 33207, 33208, 33212, 33213, 33214, 33216, 33217, 33222, 33234, 33235, 33240, 33249;


This edit is looking for 33249 to be coded as a primary code with 33225 but this procedure was only to upgrade to a Bi-V system and swap out the generator. We are getting the same edit when coding 33229 and 33225 together as well. Would anyone have any suggestions on how to code these cases. Has anyone heard of any facilities running into this edit? Any information anyone can provide would be greatly appreciated.
 

slicksurfer

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An “Errata”(AMA Corrections Document – CPT 2012) from AMA's website, revised on May 23rd, 2012, stating that we did indeed coded correctly for this case. We will be resubmitting this claim with the Errata PDF file attachment.

Page 8:
Surgery
Cardiovascular System
Heart and Pericardium
Pacemaker or Pacing Cardioverter-Defibrillator
+▲33225 Insertion of pacing electrode, cardiac venous system, for left ventricular pacing, at time of insertion of pacing cardioverter-defibrillator or pacemaker pulse generator (including upgrade to dual chamber system and pocket revision) (List separately in addition to code for primary procedure)
(Use 33225 in conjunction with 33206, 33207, 33208, 33212, 33213, 33214, 33216, 33217, 33221, 33222, 33228, 33229, 33230, 33231, 33233, 33234, 33235, 33240, 33249, 33263, 33264)
 
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