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Insertion Pacemaker for Bi-Ventricular Pacing, Dx CHF, Cardiomyopathy, LBBB

Christine Posted Tue 09th of June, 2015 18:34:47 PM

Can you help us with Coding question for placement Pacemaker 33208, plus LV lead 33225 for Bi-V Pacing? The NCD,I find for 33208 is quite restrictive for "payable" Dx/s, concentrating mostly on those Dxs/condition S.A. and A.V. Nodal dysfunction and other Brady-Arrhythmias. There is also, as you know, the consideration for the "KX" Modifier. Where we are having problem is with billing 33208, 33225 for conditions CHF, Cardiomyopathy, Lt BBB to accomplish "Resynchronization". Dx codes for CHF, Cardiomyopathy, LBBB, are not on the NCD, causing denial. I appreciate the Phys. "Care Plan" for "Resynchronization Therapy", but how do we accomplish the billing? Is 33208, 33225 incorrect billing new implant Pacemaker, Bi-V Pacing? If so, what is your suggestion for Coding this service?
Thanks so much

SuperCoder Answered Wed 10th of June, 2015 09:25:30 AM

I understand the concern, but as far as coding is concerned this is fine, you need to code CPT 33208 and 33225 for billing new implant Pacemaker, Bi-V Pacing. You need to contact the payer for knowing what you can do to get the coverage.

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