Cardiology Coding Alert

Celebrate a simpler way to report single electrode repair in a dual-chamber system.

Each CPT Codes seems to bring a massive overhaul of a different cardiology coding area, and 2012 will be no exception. Starting January 1, you'll report pacemaker and pacing cardioverter-defibrillator surgical services in an all new way.

To help ease the task of mastering these changes, Cardiology Coding Alert will begin with the big picture view of the new codes in this issue, and then will dig even deeper into practical applications of the updated codes over the coming months.

Complete System: 33206-33208 and 33249 Get a Facelift

Pacemaker and pacing cardioverter-defibrillator codes are in the spotlight in 2012, and the updates begin with codes for complete systems.

CPT® will add the following bold, italicized text to the definitions of 33206-33208: "Insertion of new or replacement of permanent pacemaker with transvenous electrode(s) ..."

For a pacing cardioverter-defibrillator, 33249 changes as follows:

• 2011: Insertion or repositioning of electrode lead(s) for single or dual chamber pacing cardioverter-defibrillator and insertion of pulse generator
• 2012: Insertion or replacement of permanent pacing cardioverter-defibrillator system with transvenous lead(s), single or dual chamber.

Electrode Repair Receives a Needed Update

When you need to code electrode repair, you'll choose between these revised codes:

• 33218, Repair of single transvenous electrode, permanent pacemaker or pacing cardioverter-defibrillator
• 33220, Repair of 2 transvenous electrodes for permanent pacemaker or pacing cardioverter-defibrillator.

Helpful: The change solves confusion over how to code repair of a single electrode in a dual-chamber system. In 2011, the code definitions offer no obvious solution because 33218 refers to repair of one electrode in a single-chamber system and 33220 references repair of two electrodes in a dual-chamber system.

2 Codes No Longer Needed for Battery Change

Coding for removing and replacing a pulse generator at a single session will look very different in 2012. This service is often called a battery change. In 2011, you report one code for the removal and a second code for inserting the new pulse generator. In 2012, you'll report a single code that captures both the removal and the insertion.

The following new codes will describe pacemaker pulse generator removal with replacement:

• 33227, Removal of permanent pacemaker pulse generator with replacement of pacemaker pulse generator; single lead system
• 33228, ... dual lead system
• 33229, ... multiple lead system.

CPT® similarly adds codes to describe replacing a pacing cardioverter-defibrillator pulse generator:

33262, Removal of pacing cardioverter-defibrillator pulse generator with replacement of pacing cardioverter-defibrillator; single lead system

• 33263, ... dual lead system
• 33264, ... multiple lead system.

Battery removal only: In line with these changes, CPT® revises battery removal codes to indicate they are for removal only:

33233, Removal of permanent pacemaker pulse generator only (don't use with 33227-33229)

33241, Removal of pacing cardioverter-defibrillator pulse generator only (don't use with 33262-33264).

Battery insertion: Codes 33212-33213 have revised descriptors for 2012 and are joined by new code 33221:

• 33212, Insertion of pacemaker pulse generator only; with existing single lead
• 33213, ... with existing dual leads
• 33221, ... with existing multiple leads.

Likewise, the pacing cardioverter-defibrillator insertion category has changed to indicate the number of leads, with 33240 now describing "Insertion of pacing cardioverter-defibrillator pulse generator only; with existing single lead." And you'll find the following two new codes to expand that section:

• 33230, ... with existing dual leads
• 33231, ... with existing multiple leads.

Get a Taste of Code Change Consequences

In 2012, you're likely to find that you rarely report the generator insertion codes because they'll apply only "when a new generator is inserted by itself without removal of an existing generator," explains Christina Neighbors, MA, CPC, CCC, ACS-CA, charge capture reconciliation specialist and coder at St. Joseph Heart & Vascular Center in Tacoma, Wash.

You'll be more likely to use the new generator change out codes (33227-33229 and 33262-33264), Neighbors says.

Fee fall out: Unfortunately, the American College of Cardiology (ACC) calculates the change to a single code for the combined removal and replacement of the pulse generator will result in roughly a 29 percent decrease from 2011 payment rates under Medicare.

This drop is large compared to the expected overall impact for cardiologists of negative 2 percent under Medicare's 2012 Physician Fee Schedule, noted by ACC CEO Jack Lewin, MD, in his Nov. 1, 2011, blog post (http://blog.cardiosource.org/post/No-Rest-for-the-Politically-Weary.aspx).

And keep in mind that the 2 percent cut is distinct from the possible 27.4 percent cut to overall Medicare payments due to the Sustainable Growth Rate (SGR). Even CMS officials agree that the 27.4 percent cut would be devastating: "This payment rate cut would have dire consequences that should not be allowed to happen," said CMS administrator Donald Berwick, MD, in a Nov. 1 statement. "We need a permanent SGR fix to solve this problem once and for all." Experts remain hopeful that the government will offer at least a temporary fix before the pay cuts kick in (as the government has done almost every year in the last decade).