# New codes



## twizzle (Jan 24, 2012)

Does anyone know how to bill pacer or ICD generator changes with placement of a LV lead utilizing the new 2012 codes? Neither my colleague nor I can work it out.


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## krisfelty (Jan 24, 2012)

71090- Deleted, fluoroscopy is included in all procedures. 

New CPT Codes:

33221- Insertion of pacemaker pulse generator only; with existing multiple leads. 

33224- Insertion of pacing electrode, cardiac venous system, for left ventricular pacing w/attachment to previous placed pacemaker or pacing cardio-defibrillator pulse generator (includes pocket revision, removal, and insertion of existing generator)

33227- Removal of permanent pacemaker pulse generator w/ replacement of pacemaker pulse generator, single lead system

33228- Removal of permanent pacemaker pulse generator w/ replacement of pacemaker pulse generator, dual lead system

33229- Removal of permanent pacemaker pulse generator w/ replacement of pacemaker pulse generator, multiple lead systems.

### These 3 above replace the 33213, 33233. We will only bill for one code, either single or dual or multiple lead. 

33230- Insertion of pacing cardio-defibrillator pulse generator only w/ existing dual leads. 

33231- Insertion of pacing cardio-defibrillator pulse generator only, w/ existing multiple leads.


33262- Removal of pacing cardio-defib pulse generator w/ replacement of pacing cardio-defibrillator pulse generator, single lead system 

33263- Removal of pacing cardio-defib pulse generator w/ replacement of pacing cardio-defib pulse generator, dual lead system

33264- Removal of pacing cardio-defib pulse generator w/ replacement of pacing cardio-defib pulse generator, multiple lead system

### These 3 above replace the 33240, 33241. We will only bill for one code, either single, dual or multiple leads. 



Kris Felty, CPC, CCC, CCVTC


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## twizzle (Jan 24, 2012)

Thanks for the replies but I still don't see the answer. I want to bill the new codes for generator changes (33227-33229,33262-33264) but with 33225 as well for LV lead, but they cannot be billed together. No other codes seem to work either.


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## sharper (Jan 24, 2012)

According to the Cardiac Rhythm Management Coder: Code 33225 is reported when the lead placed within the coronary sinus is connected to a new pacemaker generator or ICD.  *This code is also reported when the existing pacemaker generator or ICD is removed and replaced or upgraded.*
That being the case, you should be able to bill both.

Hope that helps,
Susan


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## twizzle (Jan 24, 2012)

Unfortunately, the verbage in CPT that goes with 33225 listing the codes it can be billed with don't include the new generator change codes. Encoder Pro also does not allow them to be billed together. That's my problem.


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## jewlz0879 (Jan 24, 2012)

wassock said:


> Unfortunately, the verbage in CPT that goes with 33225 listing the codes it can be billed with don't include the new generator change codes. Encoder Pro also does not allow them to be billed together. That's my problem.



That is weird and very frustrating, I'm sure. I wonder if CPT made a mistake? When I look at NCCI, it does not show codes for 33227-33229 to be bundled with 33225. I guess it's a possibility they did not consider that scenario. I'm not on Encoder but our edit system is allowing them to be billed.


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## krisfelty (Jan 24, 2012)

Yes they can be billed together. If a LV lead is implanted at the time of a generator change(33227-33229, 33262-33264) Report the revised LV lead code 33225. 
It may be that they are not updated in their systems yet. I have gotten this info from two very reliable, credible sources. 

Kris Felty, CPC, CCC, CCVTC


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## sharper (Jan 24, 2012)

Well, what about 33224? 
Just a thought!


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## kellyjoy86 (Jan 24, 2012)

*HELP!!! Confused on new ICD replacement code when billed with LV lead insertion 33225*

I have the same question accoring to the AMA 2012 CPT book, 33225 can not be billed with 33262-33264 which is for the ICD generator removal and replacement.  so I thought that maybe I could bill for the removal 33241 and then bill 33230 for the insertion of a new ICD with existing dual leads because my docs patient had an old ICD that had leads placed in the RT venticale and RT atrium and bill 33230 with 33225 which is okay, but then in the guidelines it states that 33241 can not be billed with 33230 and to use 33262-33264 when a ICD generator is being replacemented!!! oh this is soo cofusing because the AMA book states that 33225 of course is an add on code and has to have a primary procedure, but 33227-33229 and 33262-33264 is not considered a procedures that can be billed in conjunction with 33225!! Please someone HELP!!!


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## krisfelty (Jan 24, 2012)

Same with 33224, it can be billed as well. This you would use if attaching to previously placed generator ot defilrillator. 

Kris Felty, CPC, CCC, CCVTC


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## krisfelty (Jan 24, 2012)

@ sharper, same applies to the 33224. You can use it if inserting to a previously placed generator. 

As to the others who have conflicting information, I don't know what to tell you. However, like I said, I am going by what I know for a fact. 

K Felty, CPC , CCC, CCVTC


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## krisfelty (Jan 24, 2012)

Actually, I am going to get clarification on this for everyone on Thursday. I do see some references that state IF a lead procedure is performed during a gen change, the removal (33233, 33241) is STILL spearatley billable. These 2 codes are listed as appropriate to bill with the 33225 the add on as conjunction with. Check back on Thursday here to see what I find out. It will be in the afternoon sometime.......Kris Felty, CPC, CCC, CCVTC


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## acgtammy (Jan 24, 2012)

Boston Scientific has a free webinar explaining in detail the new codes.

healtheconomicsandreimbursement@bsci.com


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## twizzle (Jan 24, 2012)

Thank you to everyone for the replies.... it is very frustrating, especially when scenarios occur that don't seem to have a solution. I wonder if, whoever puts these code revisions together, thinks of every possible situation. I suspect not.
To my mind it would be obvious to bill the appropriate one code generator change with 33225. That is what is being done but that would be too simple.
I'll check out the Boston Scientific link anyway.
Thanks again to everyone.


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## krisfelty (Jan 25, 2012)

I have the power point from Boston Scientific and it does not elaborate on the LV lead with a generator change. However, I have my presentation from MedAxiom/BOCN from  the Cardiology conference I attended in New Orleans a few weeks ago and they say you can still bill for the removal of the old generator and also then bill for the LV lead. I have a teleconference with McVey Associates, Terry Fletcher, tomorrow so I am going to ask her about all of this. I will post what I find out tomorrow.

Kris Felty, CPC, CCC, CCVTC


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## sharper (Jan 25, 2012)

Please let us know what you find out at the seminar!!
Thanks and have a great day,
Susan


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## wspanic (Jan 25, 2012)

*CPT Assistant*

I have heard a rumor that a CPT Assistant is coming out so stay tuned. It seems to be an error that they did not add 33262-33264 to the 33225. However, the CPT Errata has already been issued and this is not in there. An alternative would be to bill 33230 with 33225. The RVU's are almost identical and it should pass all the edits. Just a thought. 

David Davis, CPC, CPC-H, CCC


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## twizzle (Jan 25, 2012)

wspanic said:


> I have heard a rumor that a CPT Assistant is coming out so stay tuned. It seems to be an error that they did not add 33262-33264 to the 33225. However, the CPT Errata has already been issued and this is not in there. An alternative would be to bill 33230 with 33225. The RVU's are almost identical and it should pass all the edits. Just a thought.
> 
> David Davis, CPC, CPC-H, CCC



33230 doesn't cover the removal though. Thanks anyway. We're going to try billing the new generator change only codes with 33225 and wait to see if they get denied.


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## theresa.dix@tennova.com (Jan 26, 2012)

kfelty said:


> Same with 33224, it can be billed as well. This you would use if attaching to previously placed generator ot defilrillator.
> 
> Kris Felty, CPC, CCC, CCVTC





Ok according to a webinar I listened to here is the skinny. See what you think


Clarifications Expected
·	What if we are going from a Dual ICD to a Bivent ICD? 
·	It involves a lead so not a “straight generator change”
·	We have a generator removal 
·	We have an LV lead insertion
·	But we didn't put in a “system”  - just added an LV lead and new generator -  Now what? 

Proposed Solution
·	In response to how we would bill for an LV lead insertion and the associated generator change the proposed solution:  
·	Use the new generator change only codes, but then also bill for the LV insertion 
·	This is a bit of an “exception” in that the procedure does involve a lead insertion – but since it does not involve a right side lead you can't use the “system” codes and then add on to those 
·	If the procedure did also involve a right side lead insertion, then you would use the system insertion codes plus the LV lead 

Will This Cause Problems?
·	Most likely the addition of an LV lead to the new generator change codes will experience claims issues
·	The LV lead code is not listed as adding on to the generator change out codes 
·	It is anticipated that a CPT Assistant article will soon be available, there should also be comments on the HRS and ACC web sites
·	Use these resources to address claims denials


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## krisfelty (Jan 26, 2012)

Ok, I had my conference with Terry Fletcher today and she did say that the correction will be coming out in the CPT assistant for the new gen codes to be included in the "use in conjunction with" the LV lead placement. 


Kris Felty, CPC, CCC, CCVTC


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## kellyjoy86 (Jan 30, 2012)

do you have any idea when the CPT assistant will be coming out?  and if the correction is going to be made be is not in affect yet, would it still be okay to bill the generator exchange codes 33262-33264 wuth the insertion of the LV lead 33225 now?  Did Terry Fletcher say we can bill those codes together now and our claims would pay?


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## twizzle (Feb 1, 2012)

I was the one who started the thread. My colleague and I decided we had to go ahead and start billing these procedures as we do a lot of them. We could find no other way to describe the scenario so we're billing the generator change-only codes with 33225 as we originally thought.
We'll see what happens.


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## mjb5019 (Feb 3, 2012)

*Coding edge feb 2012 has pacer article*

The february 2012 Coding Edge has an article entitled Rethink Pacemaker and Defibrillator Coding in 2012  that addresses this somewhat. If you are at work and have internet access (and are an AAPC member) you can access the article on line under the  continuing education tab


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