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Cardiology Coding Alert

AICD CODES, PART 1 ~ Perfect Your AICD Insertion, EP Eval and Upgrade Coding -- Here's How

Published on Mon Jan 01, 2007

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 the electrophysiologic (EP) evaluation codes completely, Neighbors says.

    True, you cannot separately report an EP evaluation and programming of a non-AICD pacemaker at the time of insertion, but you can for an AICD. You can report one of the following two codes at the time of an AICD insertion:

  • 93640-26 -- Electrophysiologic evaluation of single- or dual-chamber pacing cardioverter-defibrillator leads including defibrillation threshold evaluation (induction of arrhythmia, evaluation of sensing and pacing for arrhythmia termination) at time of initial implantation of replacement


  • 93641-26 -- with testing of single- or dual-chamber pacing cardioverter-defibrillator pulse generator.

    • The difference: When you use 93640, your cardiologist performs the EP evaluation of the AICD leads before he connects them to the pulse generator. Code 93641 represents the cardiologist testing the entire system once he connects the pulse generator.

    Example: Your cardiologist inserts a dual-chamber pacing AICD system (including transvenous leads and pulse generator) with fluoroscopic guidance. He also does an EP evaluation of the AICD pulse generator and leads with the induction of arrhythmia. You should report this as 33249, 71090-26 and 93641-26, Tupper says.

    Remember, you should not separately report the induction of arrhythmia (93618, Induction of arrhythmia by electrical pacing) and internal cardioversion (+92961, Cardioversion, elective, electrical conversion of arrhythmia; internal [separate procedure]). These services are part of 93640-93641.

    Step 4: Gear Up for Reporting Upgrades

    Your cardiologist may need to add a left ventricular (LV) lead to a single- or dual-chamber AICD for biventricular pacing.

    For this service, you'll use +33225 (Insertion of pacing electrode, cardiac venous system, for left ventricular pacing, at time of insertion of pacing cardioverter-defibrillator or pacemaker pulse generator [including upgrade to dual-chamber system] [list separately in addition to code for primary procedure]) if the cardiologist attaches the LV lead during the time of initial implantation. In other words, you'll use 33225 when your cardiologist inserts a new system and left lead at the same time, Tupper says.

    Example: Under fluoroscopic guidance, your electrophysiologist implants a biventricular device with leads in the right atrium, right ventricle, and coronary sinus. He conducts an EP test of the system after he implants everything. In this case, the correct codes are 33249, 33225, 93641-26 and 71090-26  

    Remember, you should avoid separately reporting coronary sinus venography because code 33225 includes this service.  

    Note: Do you know how to report the insertion/replacement of an AICD pulse generator? What about the insertion/replacement of AICD electrodes? For this information, as well as coding the repair, repositioning, or revision of AICDs, check back for Part 2 of this AICD coding series in the February Cardiology Coding Alert.

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