Cardiology Coding Alert

Tip: You can report EP evaluations at the time of AICD insertions If you're overwhelmed by automatic internal cardioverter defibrillator (AICD) coding, you could use some direction, right? Our experts offer these four step-by-step guidelines to help you find your way through the maze of components when selecting AICD procedure codes.

Best advice: As coders, we have to become very familiar with procedure codes because the procedures are not always cut-and-dry, says Sarah Tupper, CMC, coder at Central New York Cardiology PC in Utica, N.Y. Step 1: Beef Up Your AICD Basics First, you should know the type of device the cardiologist implants, understand the functions of this type, and how the cardiologist uses it, says Christina Neighbors, MA, CPC, charge capture reconciliation specialist for Franciscan Health Systems in Tacoma, Wash.

A dual-chamber AICD typically requires two leads: one pacing lead placed in the right atrium (RA), and the other lead, a defibrillator lead, placed in the right ventricle (RV). On the other hand, a single-chamber AICD uses only an RV lead.

Cardiologists will provide patients with AICDs when they have a known or detected arrhythmia. Another reason may be as a primary prevention for patients who are at increased risk of sudden death due to severe cardiomyopathies.

Other names: When you look to your cardiologist's documentation, you may see the following terms to represent AICDs: ICD (implantable cardioverter defibrillator), defibrillator, high-power device, high-voltage device, shock box, and anti-tachycardia device.

Important: AICD procedures have a 90-day Medicare global period. Codes with a 90-day global period are considered major surgeries. If a decision-for-surgery E/M is performed on the same day as or the day before an unscheduled surgery, you should append modifier 57 (Decision for surgery) to receive separate payment for the E/M code.

Step 2: Secure Your Insertion Coding When you report the insertion of an AICD system that includes the pulse generator and one or more transvenous electrodes, your coding options include:

33249 -- Insertion or repositioning of electrode lead(s) for single- or dual-chamber pacing cardioverter-defibrillator and insertion of pulse generator

71090-26 -- Insertion pacemaker, fluoroscopy and radiography, radiological supervision and interpretation; professional component. Example: If your cardiologist inserts a single-chamber pacer AICD system (transvenous leads and pulse generator), you should report 33249.

You'll use this code regardless of whether the AICD is a single or dual system, unlike pacemaker codes (33206-33208), which you'll report based on the number of leads and where the cardiologist positions the leads, says Krista Jackson, CPC, coding and compliance coordinator for Northeast Cardiology Associates in Bangor, Maine.

Remember, to report 71090-26, your cardiologist must document that he used fluoroscopic guidance, Tupper says.  Step 3: Ease Your EP Coding Challenges When you're dealing with AICDs, you must understand [...]