Cardiology Coding Alert
4 Tips Help You Master LV Lead Implant Basics
The left ventricular lead, which is attached to a pacing ICD, achieves biventricular pacing, which has been proven to benefit patients with congestive heart failure. The following pointers will help boost your LV lead reporting accuracy:
1. Distinguish old from new devices. Identify whether the physician is adding the LV lead to an already-implanted generator or if the lead is being implanted and attached to a new device. You code the lead add-on with different codes, depending on whether the patient already has a generator or if the ICD is new.
2. Report CPT 33224 for biventricular upgrades. You should use 33224 (Insertion of pacing electrode, cardiac venous system, for left ventricular pacing, with attachment to previously placed pacemaker or pacing cardioverter-defibrillator pulse generator [including revision of pocket, removal, insertion and/or replacement of generator]) if the cardiologist upgrades an already-implanted system to biventricular device by adding a left ventricular lead, says Brian Outland, coding and reimbursement specialist with North American Society of Pacing and Electrophysiology.
3. Don't forget the fluoro. Frequently, you will report 33224 with fluoroscopy (71090) because this is necessary to advance the lead. On the other hand, venography, which is also necessary for LV lead placement, is not separately billable, according to the AMA.
4. Use 33225 for new system attachments. If the physician attaches an LV lead to a new system, bill +33225 (Insertion of pacing electrode ... for left ventricular pacing) in addition to the main procedure code, Outland says. For instance, when the cardiologist inserts a single- or dual- chamber pacing cardioverter-defibrillator pulse generator, report both 33225 and 33240 for the generator insertion.
Note: Keep in mind that the technique, skills and tools for LV lead implants are different from lead placement in the right ventricle and atrium, says Cynthia Swanson, RN, CPC, a cardiology coding specialist with Seim, Johnson, Sestak and Quist LLP in Omaha, Neb. You should review the procedure report to ensure the medical record documentation supports billing these codes, she says. Also, some Medicare carriers have local medical review policies (LMRP) on these services, and practices should be familiar with the LMRP guidelines and billing requirements.
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