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Coding, Coverage, and Reimbursement Resources

Cardiac Rhythm And Heart Failure

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FAQ

FAQ

Q: What code is reported for billing by the Physician or AHP (NP or PA) for periprocedural programming of a pacemaker?

A: When coding periprocedural programming of a pacemaker, report CPT 93286.

  • If performed in a hospital setting, the professional would report both 93286-26 and 93286-26-76 (or -77) if programming evaluation is performed before and after a surgery, procedure or test.
  • In the office setting, such as when a patient may need a device adjusted before and after a stress test, report 93286 and 93286-76 (or -77).

 

Q: Can I code a pocket revision when upgrading a dual chamber ICD to a
Biventricular ICD?

A: No. You would not report the pocket revision. In 2014, the descriptions for CPT codes 33222 and 33223 were changed from relocation and revision of skin pocket for pacemaker/ICD to relocation of skin pocket for pacemaker/ICD. The term "revision" was removed from the code descriptions. For this scenario, report 33225 (insertion of the LV lead) with 33264 (system replacement with three active leads).


 

Q: A physician inserts a dual chamber pacemaker generator that recently received FDA approval. I believe that FDA approval also means that Medicare will automatically pay for this implant. Is this correct?

A: No. FDA approval does not ensure that Medicare or Private payers will provide coverage for this service. It is up to the payer to examine evidence and then determine whether coverage will be granted.


 

Q: How does a physician bill when removing a dual chamber pacemaker generator, capping the right ventricular pacing lead and then inserting a dual chamber implantable defibrillator generator as well as a right ventricular (RV) shocking/pacing lead?

A: Procedure code 33233 (Removal of permanent pacemaker pulse generator only)
and
33249 (Insertion or replacement of permanent implantable defibrillator system, with transvenous lead(s), single or dual chamber)

Rationale: When going from a Pacemaker to an Implantable Defibrillator, the generator remove and replacement codes are not applicable.

  • Use the code for the removal of the pacemaker generator, 33233.
  • A RV lead and an Implantable Defibrillator generator makes an ICD system, 33249.

Applicable modifiers such as modifier -51 and Q0 may also be required.

This information does not replace seeking coding advice from the payer and/or your coding staff. The ultimate responsibility for correct coding lies with the provider of services. Please contact your local payer for their interpretation of the appropriate codes to use for specific procedures. Medtronic makes no guarantee that the use of this information will prevent differences of opinion or disputes with Medicare or other third party payers as to the correct form of billing or the amount that will be paid to providers of service.

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