# 33227, 33222-59



## gjja (Jun 10, 2013)

Just checking if this appropriate to bill for a permanent pacemaker single lead generator change and a pocket revision. Documentation states the pocket was extended to accommodate a new permanent pacemaker. Does that suffice for doc requirements?


----------



## twizzle (Jun 10, 2013)

gjjaaron@juno.com said:


> Just checking if this appropriate to bill for a permanent pacemaker single lead generator change and a pocket revision. Documentation states the pocket was extended to accommodate a new permanent pacemaker. Does that suffice for doc requirements?



No it definitely doesn't. Billing your revision (in your case just extending the pocket) does not constitute extensive revision.  The revision has to be for reasons such as migration of the device such that it ends up in the axillary region, superficiality of the pocket causing pain or discomfort, fibrosis etc. I only bill it for those reasons, and usually only if a completely new pocket is created. What diagnosis are you going to use by the way?


----------



## gjja (Jun 11, 2013)

Thank you so much for your reply. It was very helpful. The diagnosis is 426.0. for one patient and 426.10 for another patient. So I am just billing the 33227 then. Any problems you know of with those diagnoses. I am new to the cardiology field. I can't find an LCD in NGS for the diagnosis codes.


----------



## twizzle (Jun 11, 2013)

gjjaaron@juno.com said:


> Thank you so much for your reply. It was very helpful. The diagnosis is 426.0. for one patient and 426.10 for another patient. So I am just billing the 33227 then. Any problems you know of with those diagnoses. I am new to the cardiology field. I can't find an LCD in NGS for the diagnosis codes.



You really need to bill V53.31 as primary diagnosis and your 426.0 or 426.10 as secondary if the replacement is for battery depletion.This shows that the encounter is due to battery depletion rather than another diagnosis such as a breakdown of the device or another cardiac Dx. The same goes for change of an ICD generator except you use V53.32 and your second Dx code( the reason the device was implanted in the first place). Check under the "Tips" in icd-9 under 996.0
426.0 or whatever would not be payable for your pocket revision. If it is extensive, as I explained, 996.72 usually (but not always) pays.


----------

