Cardiology Coding Alert

CPT now contains a handful of brand-new pacemaker and cardioverter defibrillator codes, including freshly minted codes for biventricular procedures, and if you're not up-to-speed on the latest, you could soon be losing out on precious reimbursement dollars. Even so, as this issue goes to press, CMS has delayed release of its final Physician Fee Schedule for 2003. Coding consultants say this delay in releasing relative value units (RVUs) for these codes could mean that if you bill them before the schedule goes into effect, you will likely receive denials. But the RVUs will go into effect this year, so billers and coders should be ready.

To code biventricular procedures accurately, you must have a clear understanding of whether the cardiologist is inserting a new pacemaker system with biventricular capability or upgrading an old system. You should also know how to apply the new code for coronary sinus lead repositioning. Swap 33999 for New Codes CPT 2003 contains three new codes that specifically address biventricular device implantation and coronary sinus lead repositioning:

33224 Insertion of pacing electrode, cardiac venous system, for left ventricular pacing, with attachment to previously placed pacemaker or pacing cardioverter-defibrillator pulse generator (including revision of pocket, removal, insertion and/or replacement of generator)     +33225 Insertion of pacing electrode, cardiac venous system, for left ventricular pacing, at time of insertion of pacing cardioverter-defibrillator or pacemaker pulse generator (including upgrade to dual chamber system) (list separately in addition to code for primary procedure)     33226 Repositioning of previously implanted cardiac venous system (left ventricular) electrode (including removal, insertion and/or replacement of generator).   Previously, cardiology coders used 33999 (Unlisted procedure, cardiac surgery) to report biventricular device implantation, in addition to 33207 (Insertion or replacement of permanent pacemaker with transvenous electrode[s]; ventricular) for right and left ventricular pacing or 33208 ( atrial and ventricular) for right atrium and biventricular pacing. CPT's inclusion of the new codes in 2003 eliminates the need for an unlisted-procedure code to describe the additional left-ventricular lead insertion, coding consultants confirm. The New CPT Code approval process started before Medtronic Inc. received U.S. Food and Drug Administration (FDA) authorization for its InSync biventricular pacing system in August 2001, says Amy Melnick, director of government relations for the North American Society of Pacing and Electrophysiology (NASPE).

"Our members were part of the clinical trials, and we knew, based on the trial results, that the device would be approved," Melnick says. She notes that NASPE is considering developing new codes for remote monitoring of pacemakers. Biventricular Devices Benefit CHF Patients Typically, patients with advanced degrees of congestive heart failure (CHF) receive biventricular implants. Consequently, coders should [...]