Pacemaker Upgrade coding

donsqueen

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Hi All,

I need some cardio expert advice. Physician upgraded single chamber pacemaker to dual chamber pacemaker. I chose CPT 33214, Upgrade of implanted pacemaker system, conversion of single chamber system to dual chamber system (includes removal of previously placed pulse generator, testing of existing lead, insertion of new lead, insertion of new pulse generator). Farther down in the description for this procedure (in Ingenix Encoder Pro), it states in part...."The generator is inserted into the pocket. If the generator is being replaced, the old pacemaker generator pocket is opened and the old generator removed in a separately reportable procedure." Because of this, my auditor states I should also code CPT 33241, Subcutaneous removal of single or dual chamber pacing cardioverter-defibrillator pulse generator. I maintain that the description of the CPT code overrules the lay description created by Ingenix. Please advise.
 

Anna Weaver

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Kokomo, IN
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upgrade

Hi All,

I need some cardio expert advice. Physician upgraded single chamber pacemaker to dual chamber pacemaker. I chose CPT 33214, Upgrade of implanted pacemaker system, conversion of single chamber system to dual chamber system (includes removal of previously placed pulse generator, testing of existing lead, insertion of new lead, insertion of new pulse generator). Farther down in the description for this procedure (in Ingenix Encoder Pro), it states in part...."The generator is inserted into the pocket. If the generator is being replaced, the old pacemaker generator pocket is opened and the old generator removed in a separately reportable procedure." Because of this, my auditor states I should also code CPT 33241, Subcutaneous removal of single or dual chamber pacing cardioverter-defibrillator pulse generator. I maintain that the description of the CPT code overrules the lay description created by Ingenix. Please advise.
These are 2 different systems (pacemaker 33214 and defibrillator 33241). If an upgrade is used, you would code only the upgrade. If you are replacing a defibrillator, you would code the removal and the insertion.
 
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