# Reprogramming of pacemakers



## gbrunow

I'm wondering if anyone can help me.

In regard to re-programming of pacemakers, does the physician need to be present at the time in order to bill for the professional component?

Thank you for your help.


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## RKN122306

I do EP billing, if you look at the new codes, under the 2009 codes, no modifier for professional is used because it read as follows:

For example

93279-

Programming device evaluation with iterative adjustment of the implantable device to test the function of the device and select optimal permanent programmed values with (physician analysis, review and report); single lead pacemaker system.

The doc and I have both been reading these over and over and we are coming up with no modifier is needed.


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## belikenephi

*Help with Nurse interrogation of pacemakers*

I work at a hospital where the nurses do the interrogation on the pacemakers.  Prior to the 2009 CPT codes it did not specify that a physician did the interrogations.  The only code that we have come up with to use for the nurse would be:

93724--Electronic analysis of antitachycardia pacemaker system (includes electrocardiographic recording, programming of device, induction and termination of tachycardia via implanted pacemaker, and interpretation of recordings.)

However, this can only be used with tachycardia.  What about the nurse interrogation and re-programming for A-fib?  We do not want to use the unlisted cardiovascular service or procedure code (93799) since it would not match the value of the interrogation.  Has anyone else encountered this problem?

Please help—
Thanks 
Leanne, CPC


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## deeva456

These new codes can be very confusing. I looked at the Medicare fee schedule and it lists the fees for the pacemaker codes with both TC and 26 modifiers. So, according to Medicare, it appears you can bill for the professional portion only. I hope this is correct as we have billed out several claims with a 26 modifier. 

To answer the first question; the physician does not have to be present for the interrogation.


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## medmom

*medmom*

Regarding the reprogramming of pacemaker, the physician does not need to be present.  I do however have a question if anyone out there can assist me. 

For CPT 93293 cardiac device monitoring telephone analysis, from what I understand this is billable only 1x in 90 days, is there any acception to this. I don't believe there is but some are saying this can be billed more than once.


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## Salemcoder

*Pacemaker interrogation*

If a device check is done in the office with no rep (physician or trained nurse) you could bill the global code correct?  (Like 93288 or 93289).
We have been billing them without modifier 26.

Also, would you bill the codes for iterative adjustment when reprogramming is done, and the other codes when programming is not done?  Some in our office interpret the codes that list with "iterative adjustment" as the initial programming only.


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## deeva456

Hi, 

Here is your question: 

_If a device check is done in the office with no rep (physician or trained nurse) you could bill the global code correct? (Like 93288 or 93289)._
_We have been billing them without modifier 26._

Yes, you are correct. You would bill 93288 or 93289 w/o modifier 26. 

The new code descriptions can be very tricky. I met with a rep from Boston Scientific and received reading material about the new codes and billing information and this is how it was explained to me. 

You can bill 93288 (with iterative adjustments) whether reprogramming is done or not.  Iterative adjustments mean the rep or MD, whoever is doing the device check, is making adjustments to see how the device or pt reacts to the different settings. After checking the different settings then the rep or MD can determine if the settings need to be reprogrammed or not. Does this make sense?

I would check with your device rep and ask if they have additional material that explains these new codes.  One of our device suppliers is Boston Scientific and they have been very helpful is teaching our MD's the new codes.  

Dolores, CPC, CCC


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## gbrunow

*EKG'S & the new programming and interrogation codes*

In regard to ekg's and the new programming and interrogation codes (93280, 93288)

Per CCI  version 15.1, the ekg is a column two component of 93280 and 93288.

If I'm understanding this correctly the EKG should be inclusive of the two new codes pointed out above?

Thank you.


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## deeva456

Yes, you are correct. The EKG is inclusive with 93280 & 93288. If the EKG is done at a different time of day, apart from the pacemaker interrogation and not during the same encounter as the pacer ck,  then you would bill the EKG with modifier 59 if supported in your documentation.  This has only happened a couple of times in our practice.


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## NeoCoder116

*Medicare policy for 93289 and physician presence*

Does anyone here have the actual link from CMS (2009 regulations) that backs up the argument that a provider does not need to be present for the interrogation of the ICD? Any help would be greatly appreciated!


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## geigert

The way I look to see if the physician needs to be present when a test is performed is go to the Physician Fee Schedule Search on the CMS website.  Do a Payment Policy Indicator Search and one of the columns will be PHYS SUPV.

Put in the code you want to search. I put in code 93289 for Interrogation of ICD and it comes up with Physician Supervision of 02.  To know what 02 means look at the How to Use The Searchable Medicare Physician Fee Schedule (MPFS) link.  

On page 26 it says that 02 = Procedure must be performed under the direct supervision of a physician.  CMS's definition of direct supervision is:
Direct supervision in the office setting means the physician must be present in the office suite and immediately available to furnish assistance and direction throughout the performance of the procedure. It does not mean that the physician must be present in the room when the procedure is performed.

So it looks like for ICD interrogatin the physician does not have to be in the room when this is being done but needs to be in the office.

link for physician fee schedule:
https://www.cms.gov/apps/physician-fee-schedule/license-agreement.aspx

link for Ho to Use The Searchable Medicare Physician Fee Schedule:
http://www.cms.gov/Outreach-and-Edu...s/downloads/How_to_MPFS_Booklet_ICN901344.pdf


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