Cardiology Coding Alert

Cardiology Coding:

Identify 3 Common Devices Your Cardiologist May Use

Hint: ICDs treat ventricular tachycardia.

Sharon Jane Oliver, CPC, CDEO, CPMA, CRC, discussed various devices cardiologists use to treat different conditions in patients such as bradycardia, tachycardia, and arrhythmias, at the 2024 Regional HEALTHCON session “Cardiology: Conditions, Procedures, and Devices.”

Use this information to figure out how to code various devices utilized in your practice.

Device 1: Pacemakers Used to Treat Bradycardia

A pacemaker system includes the battery and the leads, according to Oliver. You can have single, double, or triple leads.

Pacemaker codes include 33202 (Insertion of epicardial electrode(s); open incision (eg, thoracotomy, median sternotomy, subxiphoid approach)) through 33238 (Removal of permanent transvenous electrode(s) by thoracotomy), Oliver said.

“Pacemakers are used to treat bradycardia,” Oliver added. “The heart normally beats at a rate of 60 to 100 times a minute. If you have bradycardia, your heart is beating at a rate slower than 60 times a minute.”

Signs and symptoms of bradycardia include dizziness, fainting spells, fatigue, shortness of breath, and confusion.

There are two types of bradycardia, per Oliver:

Sinus node dysfunction: This type of bradycardia occurs when the electrical system from the sinoatrial (SA) node slows or disappears completely, and the SA node does not produce enough beats.

Atrioventricular block: In this type of bradycardia, not all heartbeats can travel from the top chamber to the bottom chamber of the heart. If it senses that the heart is beating too slowly or is pausing too long between beats, the pacemaker delivers electrical impulses that stimulate the heart and keep it beating at the proper pace, Oliver said.

The different levels of severity for AV block include the following, according to Oliver:

  • I44.0 (Atrioventricular block, first degree). This is a first-degree AV block, which is a delay in conduction at the AV node.
  • I44.1 (Atrioventricular block, second degree). This is a second-degree AV block, which is an interruption of electrical impulses below the AV node in the bundle of His through the Purkinje fibers. Code I44.1 also includes atrioventricular block, types I and II; Möbitz block, types I and II; second-degree block, types I and II; and Wenckebach’s block, per the ICD-10-CM manual.
  • I44.2 (Atrioventricular block, complete). This is a third-degree AV block, which is when a lesion distal to the bundle of His causes a right and left bundle branch block and prevents electrical impulses from traveling the normal pathway. Code I44.2 also includes complete heart block NOS and third-degree block, according to the ICD-10-CM manual.

Device 2: Implantable Cardioverter Defibrillators Discover Tachycardia

A pacemaker is continuous and does all the work, Oliver said. On the other hand, an implantable cardioverter-defibrillator (ICD) “pops” when the heart doesn’t function correctly, Oliver said. “Otherwise, you’re kind of working on your own.”

Codes for ICDs include 33240 (Insertion of implantable defibrillator pulse generator only; with existing single lead) through 33273 (Repositioning of previously implanted subcutaneous implantable defibrillator electrode).

ICDs are designed to treat life-threatening rapid rhythms (tachycardias) or cardiac arrest, Oliver said.

Ventricular tachycardia is the main type of tachycardia that ICDs treat, she said. With ventricular tachycardia, the ventricles beat so fast that they do not have time to fill with blood. The heart cannot pump enough blood to meet the body’s needs. If an episode lasts more than 30 seconds or so, it can cause fainting, shortness of breath, and chest pain. Ventricular tachycardia may develop into ventricular fibrillation and cardiac arrest.

ICD-10-CM codes for ventricular tachycardia include the following:

  • I47.20 (Ventricular tachycardia, unspecified)
  • I47.21 (Torsades de pointes). A “code also” note instructs you to also code I45.81 (Long QT syndrome) if applicable. You should also use an additional code for adverse effect, if applicable, to identify the drug (T36- [Poisoning by, adverse effect of and underdosing of systemic antibiotics] through T50- [Poisoning by, adverse effect of and underdosing of mineralocorticoids and their antagonists])
  • I47.29 (Other ventricular tachycardia)

Device 3: Decipher How Holter Monitors Work

Holter monitors provide a continuous recording of the heart rhythm, Oliver said.

CPT® codes for Holter monitoring include 93224 (External electrocardiographic recording up to 48 hours by continuous rhythm recording and storage; includes recording, scanning analysis with report, review and interpretation by a physician or other qualified health care professional) through 93248 (External electrocardiographic recording for more than 7 days up to 15 days by continuous rhythm recording and storage; review and interpretation).

You must pay attention to the medical documentation to choose the appropriate Holter code because the amount of time the device was used for monitoring is key.

Up to 48 hours of recording: For example, report 93224 through 93227 (External electrocardiographic recording up to 48 hours by continuous rhythm recording and storage; review and interpretation by a physician or other qualified health care professional) for the physician’s review and interpretation only of up to 48 hours of continuous recording. Code 93224 is what you will report for global Holter monitoring when your cardiologist performs the Holter monitoring in their office, as well as where they place the monitor on the patient, record the results, remove the monitor, and interpret the results.

On the other hand, 93225 (External electrocardiographic recording up to 48 hours by continuous rhythm recording and storage; recording (includes connection, recording, and disconnection)) through 93227 (External electrocardiographic recording up to 48 hours by continuous rhythm recording and storage; review and interpretation by a physician or other qualified health care professional) are component codes you can report based on the portion of the Holter monitoring service your physician performs.

More than 48 hours and up to seven days of recording: When your cardiologist performs Holter monitoring lasting more than 48 hours and up to seven days, look to the following codes:

  • 93241 (External electrocardiographic recording for more than 48 hours up to 7 days by continuous rhythm recording and storage; includes recording, scanning analysis with report, review and interpretation). Code 93241 describes the complete service, and you should report it if your cardiologist performs all of the parts of the service, including the recording, scanning analysis with the report, and the review and interpretation of results.
  • 93242 (… recording (includes connection and initial recording). Report for echocardiogram (ECG) initial connection and recording only.
  • 93243 (… scanning analysis with report). Report for scanning analysis and report only.
  • 93244 (… review and interpretation). Report for the review and interpretation of the recording only.

More than seven days and up to 15 days of recording: For recording that lasts more than seven and up to 15 days, look to the following codes:

  • 93245 (External electrocardiographic recording for more than 7 days up to 15 days by continuous rhythm recording and storage; includes recording, scanning analysis with report, review and interpretation). Code 93245 is a complete procedure. Report for the global service if the cardiologist performs all of the parts of this service, including the ECG recording, scanning analysis with report, and review and interpretation of the results.
  • 93246 (… recording (includes connection and initial recording)). Report for initial connection and recording only.
  • 93247 (… scanning analysis with report). Report for the scanning analysis and report only.
  • 93248 (External electrocardiographic recording for more than 7 days up to 15 days by continuous rhythm recording and storage; review and interpretation). Report for the review and interpretation of the recording only.

Meagan Williford, BA, MA, CPC, Contributing Writer

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