Anesthesia Coding Alert

Hint: Z45 family will draw lines between battery and other parts.

When your anesthesia provider is called into a case involving pacemaker adjustments, you currently have three diagnosis choices based on the device involved. You’ll need to gather more details from the cardiologist for ICD-10 coding, however, to ensure you submit the correct diagnosis.

ICD-9 includes the following choices for cases when the physician fits, adjusts, removes, replaces, or reprograms a cardiac device:

• V53.31 – Fitting and adjustment of cardiac pacemaker
  
• V53.32 – Fitting and adjustment of automatic implantable cardiac defibrillator
  
• V53.39 – Fitting and adjustment of other cardiac device.

ICD-9 coding rules: The V53.3x codes apply to removal and replacement of devices, as well as reprogramming, but they are not appropriate if you are indicating only status without need for care (in that case, use ICD-9 code V45.0x, Cardiac device in situ). You should not use V53.31 to indicate mechanical complication; instead use 996.01 (Mechanical complication due to cardiac pacemaker [electrode]).

If the patient has an AICD with synchronous cardiac pacemaker, you should look to V53.32 rather than V53.31 for fitting and adjustment encounters.

ICD-10 change: You’ll still only have four code choices when ICD-10 becomes effective in October 2014, but they encompass more than the current options:

• Z45.010 – Encounter for checking and testing of cardiac pacemaker pulse generator (battery)
  
• Z45.018 – Encounter for adjustment and management of other part of cardiac pacemaker
  
• Z45.02 – Encounter for adjustment and management of automatic implantable cardiac defibrillator
  
• Z45.09 – Encounter for adjustment and management of other cardiac device.
  

ICD-10 guidelines: Under ICD-10, you’ll have to choose between two codes for pacemaker services: Z45.010 for the pulse generator and Z45.018 for any other part. You’ll still have one code for AICD services (Z45.02) and one related to other devices (Z45.09).

The includes and excludes notes accompanying the ICD-10 codes are similar to those for the ICD-9 codes. A note with Z45.010 tells you it is appropriate for replacing a pacemaker pulse generator. A note with Z45.02 explains you should use that code when the patient has an encounter for adjustment and management of an AICD with synchronous cardiac pacemaker.

Notes for the entire Z45.- range indicate the codes apply to removal or replacement of an implanted device. However, you should look elsewhere to code malfunction or other complications of a device (see T82.1-, Mechanical complication of cardiac electronic device) or the simple presence of a device (see Z95.-, Presence of cardiac and vascular implants and grafts).

Documentation: Your provider’s documentation shouldn’t need to change for you to find the proper code under ICD-10, as long as he is clear about which device and which part of a pacemaker is being serviced. For more efficient coding, make distinguishing between services related to pacemaker batteries and services related to other pacemaker parts easy on yourself. For example, you could list both codes on the superbill, or list Z45.01- and have the provider mark or circle “pulse gen” or “other.”