# need help coding pacemaker and removal of ILR



## pchandragiri (Nov 27, 2012)

Hi All,
I would greatly appreciate if someone can help code this. I am new to cardiology coding. especially, how do i code for removal of implantable loop recorder? TIA!

 11142012
The patient was prepped and draped in the usual fashion. An loban was used. After a timeout, the skin was infiltrated over 2 marked areas where the intent had been to remove the Reveal and also implant the pacemaker. The Reveal monitor was removed first by incising over the existing scar through a combination of sharp and blunt dissection, removing the generator from under the skin. This pocket was irrigated and approximated with 3-0 Vicryl and a subcuticular layer of 4-0 Monocryl. The patient was then prepped for a cephalic vein cutdown. The skin was infiltrated with Carbocaine over the deltopectoral groove and a cephalic vein cutdown performed.
No cephalic vein was isolated and a subclavian puncture was done using 2 safe sheaths to access thje central circulation. Through this, a 000model ventricular lead was advanced to the right ventricular apex where R-waves measured…threshold was 0.6 volts and impedance was 1050ohms. The lead was fixed  to the subcutaneous facia using Ethibond. Through the second safe sheath, an atrial lead which was a 000model lead was advanced to the high rate atrium. The atrial appendage was entered using a preformed guidewire. When acceptable parameters were found, the lead was screwed into position. Both leads were confirmed in their respective positions by RAO and LAO fluoroscopy. The lead was fixed. Additional slack was added to both leads because of tortuosity in the venous system. …..the pocket was closed with two layers of suture…the patient tolerated the procedure well.


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## em2177 (Nov 27, 2012)

33282 - Implantation of patient-activated cardiac event recorder.

33284 - Removal of an implantable, patient-activated cardiac event recorder. 

TIA - transient ischemic attack (435.9)

Hope this helps.


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## mannemraji (Feb 7, 2017)

*loop recorder insertion and removal*

Hi,

i Would like to know the modiifers need to append for 33282 and 33284 on same day.

kindly help


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## ngdave1 (Apr 22, 2017)

*Cardiology Billing*



em2177 said:


> 33282 - Implantation of patient-activated cardiac event recorder.
> 
> 33284 - Removal of an implantable, patient-activated cardiac event recorder.
> 
> ...




Hello   Elizabeth,


  I came across your impressive credentials. I've not had time to pursue further AAPC certfications after getting two.

Currently I'm billing for a cardiologist. East Bay near San Francisco. 

His work has increased when he took on a partner. I wanted to request you whether you knew any cardiology coding specialist familiar with Epic system.


Cardio coding is complex, but not extremely involved (total 20 to 25 CPTs); scope is limited to  cath placement, stent, CABG, 

I greatly appreciate your help. 


Regards,

Nisha

====


CPTs
92900 series
93458
93459

33249
33225

93018



https://www.aapc.com/memberarea/forums/139451-cpt-92928-93458-a.html


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