# 33282 and 33284?



## ASC CODER (Jan 3, 2011)

underwent a Reveal implantation, which initially had good sensing, however, his sensing became worse, likely secondary to some minor movement or possibly scarring. He had an episode of syncope, however, because of the under sensing of his device, it did not detect this episode. He is being brought in to remove and replace his Reveal monitor to insure that we capture his next episode of syncope.


DESCRIPTION OF PROCEDURE:
After informed consent was obtained, the patient was brought to the operating room in a fasting state. The left chest was prepped and draped in the usual fashion. Lidocaine was used to anesthetize the area over the prior incision. Incision was made, and the tissue was resected down to the previous Reveal device. The sutures were cut, and this device was removed from the pocket. The pocket that had previously existed for this device was then closed with 2-0 silk. 

Using a Metzenbaum for blunt dissection, a new pocket was made, which was laterally directed and had a vector that proved to be superior from a sensing standpoint. The device was inserted into the pocket, and it was sutured down to the pectoralis muscle at two different locations around the header. 

I am asking if I can use 33282 and 33284 with mod. 59 due to the fact it is two seperate pockets and new implant.....Anyone have opinions?


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## theresa.dix@tennova.com (Jan 5, 2011)

ASC CODER said:


> underwent a Reveal implantation, which initially had good sensing, however, his sensing became worse, likely secondary to some minor movement or possibly scarring. He had an episode of syncope, however, because of the under sensing of his device, it did not detect this episode. He is being brought in to remove and replace his Reveal monitor to insure that we capture his next episode of syncope.
> 
> 
> DESCRIPTION OF PROCEDURE:
> ...



I am thinking you need to add modifier 78 if this is still in the global period.

Code 33282 is mutually exclusive to code 33284 but a modifier is allowed in order to differentiate between the services provided.


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## ASC CODER (Jan 5, 2011)

This is in a surgery center after alittle more research it turns out they used the same device but just moved it. I am thinking 33999? ASC's can not use 78 mod.  What do you think about the unlisted?


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## theresa.dix@tennova.com (Jan 5, 2011)

ASC CODER said:


> This is in a surgery center after alittle more research it turns out they used the same device but just moved it. I am thinking 33999? ASC's can not use 78 mod.  What do you think about the unlisted?



 uh oh now i dont understand this. Why cant ASC's use modifier 78? This modifier is listed under Modifiers approved for ambulatory use(ASC) surgery center in the CPT book, but i am thinking you are saying it wasnt the SAME physician doing the procedure? No I dont think the unlisted is the way to go. Not when there is a more precise code to use. Hmm Reveals have a 90 day global


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## theresa.dix@tennova.com (Jan 5, 2011)

you are coding for the facility not the physician. I think you are meaning right?


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## ASC CODER (Jan 5, 2011)

Yes the facility, global doesn't apply.


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## theresa.dix@tennova.com (Jan 5, 2011)

yes I just figured that out by you saying you cannot use the 78 modifier.   ok. so yes I would say in that case the 59 modifier is the one to use and I think i would still use the 33284 and 33282 codes. You think that sounds good?


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## ASC CODER (Jan 5, 2011)

well here is my dilema, 33282 is a device dependant procedure and he used the same device just moved it. so I can't bill for the device. I am stuck on the previous pocket being closed and a new one opened. It is truly a revision not implanted and not removed due to the fact he put the same one back in. ugh. I will be talking to the coder at the Doc's office today and see what her imput is. I have researched this and I am not coming up with any definitive answer. 

Here is one of the examples I found
When treatment for complications requires a return trip to the operating room, physicians must bill the CPT-4 code that describes the procedure(s) performed during the return trip. If no such code exists, use the unspecified procedure code in the correct series, e.g., 47999 or 64999. In this situation, you must include operative notes with the claim or a narrative description which will allow us to understand the extent of the service performed. The procedure code for the original surgery is not used except when the identical procedure is repeated.

Now remember it is the facility...


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## theresa.dix@tennova.com (Jan 5, 2011)

ok . I will do some research and see what I find on this.


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## ASC CODER (Jan 5, 2011)

Ok here is what I found out!

There are guidelines for removal and implanting. you can only remove once during the two years. and they will only pay for one implantation in two years.  This was a revision neither implantation (with device) nor removal. The code for the Facility is unlisted. If we were to bill just a removal then when it came time to remove the same device they could not bill the removal. We are going to have the doctor specify more clearly in his note that it is the same recorder. Then send in the notes to ins. Per our contract with ins we will get paid for the unlisted. Wow not much info on this procedure you would think this would happen more frequently considering how many recorders they put in people.. Thanks for your help. If you have any other info please share.


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## theresa.dix@tennova.com (Jan 5, 2011)

haha well good I'm glad you found something out. We implant and explant all the time. I still want to see what I can find on this there isnt alot out there just as you said.


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