Cardiology Coding Alert

With the Food and Drug Administration's (FDA) approval of the Medtronic InSync cardiac resynchronization system in August 2001, the way was cleared for biventricular pacemaker implantation to help patients who have moderate to severe heart failure and remain symptomatic despite stable, optimal medical therapy.
 
Although CPT codes covers single- and dual-chamber pacemaker implantations, there are no codes to report biventricular pacemaker implantation, which involves placing leads into three separate areas of the heart, not only in the right atrium and right ventricle but also in the coronary sinus to stimulate the left ventricle. As a result, cardiologists and electrophysiologists have been receiving conflicting advice on how to code this relatively new procedure. Medtronic and the North American Society of Pacing and Electrophysiology (NASPE) recommend using one or more existing codes in addition to an unlisted-procedure code, but consultants like Nikki Vendegna, CPC, a cardiology coding and reimbursement specialist in Overland Park, Kan., recommend using only an unlisted-procedure code.
 
Until CPT addresses the problem, coders should ask carriers whether biventricular pacemaker implantation is covered and which codes to use.
Billing 33999
Coding specialists agree on using 33999 (unlisted procedure, cardiac surgery) to report biventricular pacemaker implantation, but they differ on whether 33999 should be billed alone.
 
NASPE President Eric N. Prystowsky, MD, recently recommended in a letter to NASPE members that, in addition to CPT 33999, the procedure be reported as either 33207 (insertion or replacement of permanent pacemaker with transvenous electrode[s]; ventricular) or 33208 ( atrial and ventricular). 

If fluoroscopic guidance is used, NASPE suggests adding 71090 (insertion pacemaker, fluoroscopy and radiography, radiological supervision and interpretation). NASPE and Medtronic also recommend that 75860 (venography, sinus or jugular, catheter, radiological supervision and interpretation) be billed, with Medtronic suggesting in a press release that these codes be considered "given the similarity to brady pacing."
 
Note: Although the NASPE letter also recommends 36005 (injection procedure for extremity venography [including introduction of needle or intracatheter]) for the injection procedure, this code should not be used for coronary venography in light of revisions to the code in CPT 2002, i.e., the word "extremity" has replaced the word "contrast" in the descriptor.
Unlisted-Procedure Codes
The CPT Manual does not include detailed instructions on using unlisted-procedure codes; however, CPT Executive Committee members have said in the past that unlisted-procedure codes include the entire procedure and are not meant to describe a component of a procedure.
 
"When you use an unlisted surgical procedure code, you can't piecemeal parts of the surgery and bill them separately," Vendegna says. "The unlisted code is [...]