Cardiology Coding Alert

Bottom line: Don’t report temp codes with permanent device services.

Correct Coding Initiative (CCI) 19.3, effective October 1, adds 18 new edits with 33211 (Insertion or replacement of temporary transvenous dual chamber pacing electrodes [separate procedure]) in the column 2 position and 17 new edits with 33210 (Insertion or replacement of temporary transvenous single chamber cardiac electrode or pacemaker catheter [separate procedure]) in the column 2 position, according to the CCI analysis by Frank Cohen of The Frank Cohen Group.

The column 1 codes are all related to permanent pacemaker services, and have a modifier indicator of 0. The 0 means you can’t override the edit with a modifier. The column 1 codes include:

• Pacemaker pulse generator insertion: 33212-33213, 33221
• Cardiac device pocket relocation: 33222-33223
• Left ventricle pacing electrode insertion: 33225
• Pacemaker pulse generator removal and replacement: 33227-33229
• ICD pulse generator insertion: 33230-33231
• Pacemaker pulse generator removal: 33233
• Pacing cardioverter-defibrillator pulse generator insertion: 33240
• Pacing cardioverter-defibrillator pulse generator removal: 33241
• Pacing cardioverter-defibrillator pulse generator removal and replacement: 33262-33264.

The additional edit for 33211 is a new edit bundling 33211 into 33506 (Repair of anomalous coronary artery from pulmonary artery origin; by translocation from pulmonary artery to aorta). CCI already has an edit in place bundling 33210 into 33506.

TAVR Sees New Edits, Too

Alert your TAVR team that CCI also adds edits for 33365 (Transcatheter aortic valve replacement [TAVR/TAVI] with prosthetic valve; transaortic approach [e.g., median sternotomy, mediastinotomy]), bundling in these codes:

• 32100, Thoracotomy; with exploration
• 32556, Pleural drainage, percutaneous, with insertion of indwelling catheter; without imaging guidance
• 32557, Pleural drainage, percutaneous, with insertion of indwelling catheter; with imaging guidance.

These codes have a modifier indicator of 1, so you may override the edit with a modifier when appropriate. But take care. The reason given for the 32556 and 32557 edits is “misuse of column two code with column one code,” so payers are alert to improper reporting of those pleural drainage codes with 33365.

Additionally, alert the team the edit for 33365 and 33140 (Transmyocardial laser revascularization, by thoracotomy; [separate procedure]) saw a modifier indicator change. Before Oct. 1, 2013, the edit had a modifier indicator of 1, so you could override the edit. As of Oct. 1, the edit has an indicator of 0, so you may never override the edit.