CODING CORNER: Sync Up Your CRT Payment With 4 Crucial Answers

Mismatched codes can cost up to $1150
When coding for cardiac resynchronization therapy (CRT), know the type of pacing system the physician is implanting and whether she is repositioning or replacing electrode leads -- or risk a pricey mistake.
Spot the difference: CRT, also known as "biventricular pacing," targets both the left and right heart ventricles simultaneously, whereas other pacemakers provide electrical impulses only to the right ventricle. Essentially, CRTs resynchro-nize the left ventricle muscle contraction, which improves the efficiency of the weakened heart.
Left ventricular lead services can complicate CRT coding. Indeed, coders face a host of challenges when reporting CRT services, says Jim Collins, CHCC, CPC, a coding consultant and president of Compliant MD Inc. in Matthews, N.C. Although there are several codes for lead placement and enerator implants and system upgrades (33224-33226), now there are no CPTcodes specifically for left ventricular lead removal, Collins says.
Use the following four questions to determine the correct CRT code to report when the physician completes biventricular services:
1. Did the physician insert a "total"system (generator and leads) into the patient?
Physicians may insert an entirely new system consisting of a new battery (generator) and new electrodes (leads) into the patient, or the systems may be "upgraded" by adding leads to an already implanted generator.
Tip: Your choice of codes for the additional lead to the second ventricle will depend on whether the patient already had a generator or if the system is new.
If the physician attaches a left ventricle (LV) lead to a new system, bill add-on code +33225 (Insertion of pacing electrode, cardiac venous system, for left ventricular pacing at time of insertion of pacing car-dioverter-defibrillator or pacemaker pulse generator [including upgrade to dual-chamber system] [list sepa-reately in addition to code for primary procedure]) in addition to the main procedure code. Failing to report this add-on code could cost you a whopping $1,150.
For instance, when the physician inserts a new dual-chamber pacing cardioverter defibrillator generator in the patient with the addition of a biventricular lead, report both 33225 for electrode insertion and 33240 for insertion of the dual-chamber generator.
2. Did the physician insert a cardiac resynchronization therapy pacemaker system?
During these procedures, the physician places three leads and a new dual-chamber cardiac pacing defibrillator generator. When placing the leads, she maneuvers the leads through veins from the device to the heart. The first lead is placed on the inner wall of the right atrium, the second lead touches the inner wall of the right ventricle, and the third lead is threaded through the coronary sinus and touches the outer wall of the patient's left [...]

- Published on 2004-06-10