Coding pacemaker / implantable cardioverter-defibrillator

11 important Coding guidelines for pacemaker 33202 – 33275

What is Definition pacemaker and advantageous of pacemaker:

A pacemaker is a small device used to treat some arrhythmias. During an arrhythmia, the heart can beat too fast, too slow, or with an irregular rhythm. Pacemakers send electrical pulses to help your heart beat at a normal rate and rhythm.

What is the single chamber pacemaker system:

A single chamber pacemaker system with lead includes a pulse generator and one electrode inserted in either the atrium or ventricle

What is the Dual chamber pacemaker system?

A dual chamber pacemaker system with two leads includes a pulse generator and one lead inserted in the right atrium and one lead inserted in the right ventricle. Patient will be anxious before surgery.

What is Bi-ventricular pacing?

The device consists of three wire leads and a pulse generator

One lead to atrium. Two leads to RT ventricle and LT ventricle.

What is the lead?

The leads are wires that run between the pulse generator and the heart. These leads can deliver a burst of energy in both pacemakers and ICDs. Leads also called as electrodes

Pulse generators:

These are the “battery” component of the pacemaker, which normally produces the electrical activity required to transmit to the heart musculature

Where to fix leads:

Leads may be inserted through a vein (transvenous) or they may be placed on the surface of the heart (epicardial). The epicardial location of leads requires a thoracotomy for insertion.

1. 1. Right atrium
   2. Right ventricle
   3. Left ventricle (bi-ventricular pacing)
   4. Location of Pulse generator:

Pulse generators are placed in a subcutaneous “pocket” created in either a subclavicular site or just above the abdominal muscles just below the ribcage.

List of Inclusive procedure:

1. Intravascular placement of catheters (cardiac catheterization or selective vascular catheterization )may not be reported with pacemaker /Implantable Defibrillator procedures (CPT codes 33202-33275) and Intracardiac Electrophysiology procedures (CPT codes 93600-93662)
2.  A cardiac catheterization CPT code is separately reportable if it is a medically reasonable, necessary, and distinct service performed at the same or different patient encounter.
3.  Fluoroscopy codes (e.g., CPT code 76000) are not separately reportable with the procedures described by CPT codes 33202-33275 and 93600- 93662. Fluoroscopy codes intended for specific procedures may be reported separately.
4. Ultrasound guidance is not separately reportable (76937, 76942, 76998, 93318, or other ultrasound procedural codes)
5. Electronic analysis (i.e., interrogation and programming) is integral to the insertion or replacement of a pacemaker or implantable defibrillator pulse generator. The interrogation and programming codes shall not be reported separately
6. When CPT codes 33218 and 33220 describe repair of single and 2 transvenous electrodes includes device removal, insertion, replacement, or skin pocket revision
7. if a new device is used to replace the original device, CPT codes 33227- 33229 or 33262-33264 may be reported additionally for replacement with a new device
8. Device evaluation codes 93260, 93261, 93279-93298 for pacemaker system with lead(s) may not be reported in conjunction with pulse generator and lead insertion or revision codes 33206-33249, 33262, 33263, 33264, 33270, 33271, 33272, 33273
9. Fluoroscopy (76000, 77002), ultrasound guidance for vascular access (76937), right ventriculography (93566), and femoral venography (75820) are included in 33274, 33275, when performed). DFT testing during subcutaneous implantable defibrillator system insertion is not separately reportable. DFT testing for transvenous or subcutaneous implantable defibrillator in follow-up or at the time of replacement may be separately reported using 93642 or 93644.
10. Defibrillator threshold testing (DFT) during transvenous implantable defibrillator insertion or replacement may be separately reported using 93640, 93641.
11. To report fluoroscopic guidance for diagnostic lead evaluation without lead insertion, replacement, or revision procedures, use 76000.

Steps for coding:

1. Coder’s responsibility to check below point below arriving the CPT code
2. Pacemaker or defibrillator syste
3. Approach – open incision/endoscopic/transvenous
4. Identify temporary Pacemaker or permanent pacemaker
5. Pulse generator or Electrodes (Ieads)
6. Insertion/replacement/removal/reposition/repair
7. Upgrade to dual chamber system (Biventricular)
8. Parenthetical notes to avoid the error.
9. These instructions are intended to prevent errors of significant probability are not all inclusive.