Wiki pacemaker revision

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lovelyadd

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Question my office is at a stand still. All the doctor did was expanded the pacemaker pocket and slightly moved the generator over. No relocation of pocket, no hematoma, no I&D, no debridement. One said use unlisted, I said use 13100, since Complex repairs are often reconstructive procedures and include the creation of a defect to be repaired. Any opinion helps.
 
So the doctor reopened the incision to make a revision to the pocket and placement and sealed the patient back up? Repair code does not sound correct.
 
IMO, not billable. If the pocket is modified to allow for a new generator, it is bundled in the pacemaker generator exchange code.
HTH,
Jim Pawloski, CIRCC
 
That is my problem he didn't change the generator! the patient had chest pain, they thought it might been infected, they opened him up no infection, nothing. He expanded the pocket, tested lead and generator and then moved the orginial generator over in the newly expanded pocket. I felt he did a reconsturction of the area
 
Another option may be to bill the procedure he was would have had to do if it was infected and add modifier 52 (reduced service). Either way op-notes will be required if there isn't an appropriate code to use for the service.

You cannot bill complex repair as that is not what was done. The doctor wasn't reconstructing an open wound that was there before the patient came into the office. An example of creation of a defect to be repaired would be enlarging an already open wound.
 
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thanks codingking for reminding me that the CPT guidelines DO consider this an open wound. Had it been infected the proper cpt code would be 11042, debridement subcutaneous tissue. And doing further research in 2014 when this code was changed from revision to relocation one of the cpt codes listed under the new code "to remind us to use the integumentary system" is code 13100.
 
lovelyadd said:
Question my office is at a stand still. All the doctor did was expanded the pacemaker pocket and slightly moved the generator over. No relocation of pocket, no hematoma, no I&D, no debridement. One said use unlisted, I said use 13100, since Complex repairs are often reconstructive procedures and include the creation of a defect to be repaired. Any opinion helps.
Click to expand...


I use the unlisted 17999 when the only the pocket was expanded. I would not code this as a complex repair.

HTH,
Misty Sebert CPC, CCC, CCVTC
 
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