Wiki Help with pacemaker/ICD billing

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mriney@hendrick.org

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Hello all,

I have a coding question related to pacemakers and icds... The encounter summary previously read "Patient came in today for routine 1 month pacemaker check. Threshold and sensing test performed. Pacemaker function appears to be within normal limits. No changes made. No problems or complaints. Per manufacturers guidelines, due to age of pacemaker and estimated time remaining, patient scheduled to return in 1 month". Based on the highlighted text above, our billing auditor recommended we bill the appropriate codes WITHOUT ADJUSTMENT (93288 or 93289).

Long story short, the tech is claiming "because a machine makes temporary changes at the time of interrogation" this constitutes billing WITH AN ADJUSTMENT (93279,93280, 93281, 93282, 93283 or 93284). That being said, the documentation has now been changed to read "Patient came in today for post implant pacemaker check. Threshold and sensing performed, with temporary reprogrammed in assess the pacemaker function. Pacemaker function appears to be within normal limits. No problems or complaints. Patient scheduled to return in 3 months."

I am hesitant to bill WITH ADJUSTMENT because I believe the summary has been "doctored" to fit the charge. Can anyone point me in the right direction for what actually constitutes an adjustment? The CPT book does not clearly define.





Thank you, in advance,
Marjohn Riney, BA, CMPE
 
Has the claim been denied already? If you submit a claim and it gets denied you cannot adjust documentation to get it paid. However, simply going to the doctor or technician for a query and confirmation of what was done before billing, and asking them to amend their note to reflect actual services reported is appropriate. Be cautious with this, as sometimes you won't actually know if it was really done or not, and the tech could be altering documentation so the doctor can get paid. It's tricky.
 
Did you get an answer to this? I was under the impression that most pacemaker checks were re-programmings because they do make adjustments to see if is better for the patient so it is being reprogrammed whether there are final changes or not. I was told the interrogation is pretty much a battery check that is not done often but you can tell by our pacemaker sheets when everything is checked or it is not. I am interested to find out what other clinics bill for.
 
Did you get an answer? Because it is in the CPT book.

Per the CPT book (the explanation part at the beginning of the chapter), the programming code is to be used when the threshold is checked and the programming is optimized, even if the optimal settings turn out to be the original ones. In other words, the end result may be the same but you are billing for the work done to optimize (test these parameters to ensure it is at optimal setting) even if the end result is not changed.

This is in CPT and in CPT assistant. It is the "big change" to these codes that was made back in 2009 and people keep reverting back, including payers. So just because a payer will or won't pay is not relevant. What is relevant is the work being done (and documented) matches the code being billed.
 
Go to your CPT and read what it says under Programming device evaluation right before the codes. It will tell you that the change does not have to be permanent to use the programming codes. They are called "iterative adjustments". It goes on to explain.
 
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