Proper coding tactics can overcome the main hassles in pacemaker billing, our experts say. Although coding for generator removal or replacement is essentially straightforward, when the cardiologist removes or replaces leads, coding becomes more complex, and being paid for the additional time necessary also becomes a factor.
The pacemaker comprises two basic componentsthe generator and the leads, which are the wires attached to the generator that go into the heart muscle. CPT lists a number of codes both for generator and lead removal and/or replacement. For instance, 33233 (removal of permanent pacemaker pulse generator) is used when the generator is removed but the leads remain, while 33212 (insertion or replacement of pacemaker pulse generator only; single chamber, atrial or ventricular) or 33213 (dual chamber) is the appropriate code when replacing the device. These codes should be used only when all the cardiologist does is open the skin pocket created for the pacemaker, remove the old generator and/or replace it.
Corrective Procedures are Reimbursable
Pacemaker insertion is considered major surgery and has a 90-day global period.
Sometimes the patient may dislodge one or more of the leads on the pacemaker, or the lead itself may be faulty or connected incorrectly. In those situations, the cardiologist must go back and reposition the lead. Such corrective procedures are reimbursable despite the 90-day global period; however, the specific code used in such situations varies by time, depending on whether the problem with the lead is corrected more or less than 15 days after the insertion of the pacemaker.
Denise Reckers, CRT, a respiratory therapist and a coder with Cardiology Consultants, a group practice with eight cardiologists in Abilene, TX, says there are two different kinds of pacemakerssingle and dual chamber. Single-chamber pacemakers are referred to as VVIs or AAIs, depending on whether the lead is attached to the atrium or the ventricle, while the dual-chamber pacer is commonly called a DDD.
When the cardiologist inserts a new VVI or AAI, the procedure is billed with CPT code 33207(insertion or replacement of permanent pacemaker with transvenous electrode[s]; ventricular) or 33206 (atrial). Inserting a DDD, meanwhile, is billed with 33208 (insertion or replacement of permanent pacemaker with transvenous electrode[s]; atrial and ventricular).
If the lead malfunction is corrected more than 15 days after a VVI or AAI pacemaker was installed, the procedure should be coded 33218 (repair of pacemaker electrode[s] only; single chamber, atrial or ventricular). A DDD pacemaker lead repair performed before the 15-day threshold would be billed with 33220 (dual chamber). If the repair takes place more than 15 days after the pacemaker was inserted, use code 33216 [...]