# Pacemaker Battery Replacement



## Patricia L Diaz

Need some help fellow coders..I'm new w/hosp billing...here is the scenerio...

Procedure:
right infraclavicular incision was made and previous pacemaker removed. The leads were checked, Then New pacemaker was implanted, the position of the lead and pacemker was chkd under fluoro...pt did well no complications.... proc-33207 and 77001/26???
also this is done op @ hosp...can I chg for the obs visit?


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## deeva456

Hello,

I need a little bit more information to help you. What was removed?  Was it the pacemaker generator and leads or just the generator?  What was implanted? Generator only or a whole new unit; generator with the leads. If leads were implanted how many, single or dual?  In your scenerio you can bill for both the removal and implant of the device, just need to know exactly what was done.
You are kinda on the right track, coding for fluoroscopy guidance but the code is wrong. Only one fluoroscopy code is used for both the pacemaker and ICD implants; 71090-26.

Pacemakers and ICD removals and implants have a 90 day global period, therefore you cannot bill an observation code the day of the surgery or hospital visits following the implant. 

Hope this makes sense,

Dolores, CCC-CPC


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## Patricia L Diaz

ok Dolores, the report reads


Procedure:
right infraclavicular incision was made and previous pacemaker was removed. The leads were checked. The pacing threshold was 1 volt, impedance 546 ohms, and sensing 2.4 mV. Then New pacemaker was implanted. The patient was pacing and sensing. Currently, the patiens's pacemaker is programmed at 60 per minite.The fossa was closed. The skin was closed. The position of the lead and pacemker was chkd under fluoro...pt did well no complications.... proc-33207 and 77001/26???

This is pretty much word for word from the op report...Thanks for your help!!!


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## deeva456

*re*

Hello, 

Wow, this report is missing some important information, I would code only the removal and replacement of the generator. If your doctor removed and replaced the leads he/she could dictate an addendum stating this.

So, based on this report I would send it back to him or her and tell him it is an incomplete report. At the end of the report does he/she list the serial numbers of what was removed and implanted?  If so then you can tell exactly what was done.  If you doctor refuses to clarify this procedure I would only bill for the removal of the generator, replacement of the generator and fluoroscopic guidance:

33233 - removal of permanent pacemaker pulse generator
33213 - insertion or replacement of pacemaker pulse generator only; dual chamber
71090-26 - insertion pacemaker, fluoroscopy and radiography, radiological supervision and interpretion.

I hope this has helped you,

Dolores, CPC-CCC


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## Patricia L Diaz

Thank you Dolores...you have really helped me out alot w/this!!!


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