AICD CODES, PART 2 ~ When You Remove a Component, 1 Code Won't Do The Trick
Published on Mon Jan 22, 2007
Tip: Ask yourself if the lead is the same or different Last month, you learned how to code AICD insertions, evaluations and upgrades -- but that's not the end of the story. You also need to know how to report the replacement of pulse generators and electrodes as well as the repair, repositioning and revision of an automatic internal cardioverter defibrillator. Use 2 Codes for Battery Change First, when the battery in the AICD's pulse generator nears the end of its life, the cardiologist will replace the pulse generator. In other words, he does a "battery change."
Rule of thumb: For this service, you'll report two codes -- one for the insertion of the new generator (33240, Insertion of single or dual chamber pacing cardioverter-defibrillator pulse generator) and one for the removal of the old (33241, Subcutaneous removal of single or dual chamber pacing cardioverter-defibrillator pulse generator).
Example: Your cardiologist sees a patient for a battery change. He explants the old dual-chamber AICD and inserts a new dual-chamber pulse generator. For this procedure, you should report 33240 and 33241. Note: Always list the highest valued code first. You may want to add modifier 51 (Multiple procedures) to 33241, depending on your payers' recommendations.
When you're looking for a diagnosis code to apply to this situation, you should use V53.32 for AICDs. "The code description states that it includes the removal of device, replacement of device. You should not use 996.0x [Mechanical complication of cardiac device ...] because a battery change is not an unexpected complication," says Inga Burton, CPC, certified coding specialist at Pima Heart Physicians PC in Tucson, Ariz.
Keep in mind: If your cardiologist replaces the entire AICD system (pulse generator and leads), you should report 33241 for the old pulse generator's removal, 33243 (Removal of single or dual chamber pacing cardioverter-defibrillator electrode[s]; by thoracotomy) or 33244 (Removal of a single or dual chamber pacing cardioverter-defibrillator electrode[s]; by transvenous extraction) for the lead(s) removal, and 33249 (Insertion or repositioning of electrode lead[s] for single or dual chamber pacing cardioverter-defibrillator and insertion of pulse generator) for the new system's insertion. Evaluate This Electrode Replacement Scenario Battery changes aren't all you need to know about replacements. When an electrode malfunctions, your cardiologist may need to replace an AICD electrode. If so, your coding options are:
• 33216 -- Insertion of a transvenous electrode; single chamber (one electrode) permanent pacemaker or single chamber pacing cardioverter-defibrillator
• 33217 -- ... dual chamber (two electrodes) permanent pacemaker or dual chamber pacing cardioverter-defibrillator
• 33244 -- Removal of single or dual chamber pacing cardioverter-defibrillator electrode(s); by transvenous extraction. Don't miss: In this situation, your cardiologist is going to handle two different leads. Like the changing-the-battery example above, you should report both the removal of [...]
