Follow HCFA Guidelines to Get Paid for Pacemaker Checks
Published on Fri Sep 01, 2000
Unless local Medicare carriers have their own policies regarding pacemaker checks, the Health Care Financing Administrations (HCFA) guidelines, first formulated in 1984, still apply. These guidelines are endorsed by pacemaker manufacturers such as Medtronics and supported in statements by the American College of Cardiology (ACC), and adhered to by the North American Society of Pacing and Electrophysiology (NASPE).
Many cardiology practices, however, are uncertain how often they can perform and bill for pacemaker evaluations because they are confusing in-clinic visits with transtelephonic monitoring.
The guidelines, which are found in section 50-1 of HCFAs Coverage Issue Manual, detail the appropriate frequency of both in-clinic and telephonic monitoring of pacemakers.
An Understanding of Pacemakers
Pacemaker systems, which consist of two parts a pulse generator and either one or two leads, or wires send electrical signals that regulate the heart when the hearts natural pacemaker, the sino-atrial (SA) node, improperly alters the rate at which it sends electrical signals to the heart, or when there is inadequate conduction of that signal to the ventricular heart chambers.
There are two basic kinds of pacemakers. A single-chamber pacemaker has one lead to carry signals to and from one chamber of the heart either the right atrium or the right ventricle. A dual-chamber pacemaker has two leads, with the tip of one lead positioned in the right atrium and the tip of the other lead located in the right ventricle.
After a pacemaker is implanted, follow-up care usually is performed on a regular basis. Monitoring is performed by telephone (transtelephonic analysis) or in a cardiologists office (in-clinic). Pacemaker checks often are performed by physician assistants, nurses or technicians specially trained in management of pacemakers.
Pacemaker checks performed in the office or clinic are billed using 93731(electronic analysis of dual-chamber pacemaker system [includes evaluation of programmable parameters at rest and during activity where applicable, using electrocardiographic recording and interpretation of recordings at rest and during exercise, analysis of event markers and device response]; without reprogramming), and 93734 (single-chamber system, without reprogramming).
If the pacemaker requires reprogramming, use 93732 (dual chamber, with reprogramming) and 93735 (single chamber, with reprogramming).
CPT provides the following two codes for telephonic analysis: 93733 (telephonic analysis, dual-chamber system) and 93736 (single chamber system).
HCFAs Frequency Guidelines
In October 1984, HCFA published guidelines for pacemaker evaluation services to help its carriers limit excessive claims development to those cases requiring special attention. Accordingly, most Medicare carriers, such as Trailblazer Health Enterprises (Texas, Maryland, Delaware, Virginia and the District of Columbia), Missouri General [...]
