New ICD Codes May Eliminate Billing Confusion
Published on Sat Jul 01, 2000
Billing for the implantation and/or removal of implantable cardioverter-defibrillator (ICD) devices can be difficult. But with the revised procedure codes in CPT 2000, billing them step by step will gain proper reimbursement.
In what may be the most important revision, CPT 2000 specifically states that codes 33240-33249 should be billed for single- or dual-chamber insertions and/or removals. Previously, dual-chamber ICDs were not mentioned specifically, and providers could bill an additional fee for implanting or removing a dual-chamber device by adding modifier -22 (unusual procedural services) to the appropriate procedure code. Because the code now includes dual-chamber systems, modifier -22 should no longer be billed.
Although this change may cut reimbursement in some situations, the new wording better describes the ICD devices now in use by electrophysiologists. It is intended to address the rapidly changing technology of ICDs, some of which now combine dual-chamber pacing with cardioversion/defibrillation.
The implantable automatic defibrillator is an electronic device designed to detect and treat life-threatening tachyarrhythmias. Like pacer systems, ICDs have two components: a pulse generator and one or more electrodes. All modern ICDs have at least single-chamber backup pacing, but their main function is to treat ventricular tachycardia or fibrillation.
CPT codes 33240-33249 describe the insertion (implantation) and/or removal of either the pulse generator, the electrodes, or both. They are broken down as follows:
33240 insertion of single or dual chamber pacing cardioverter-defibrillator pulse generator
33241 subcutaneous removal of single or dual chamber pacing cardioverter-defibrillator pulse generator
33243 removal of single or dual chamber pacing cardioverter-defibrillator electrode(s); by thoractomy
33244 by transvenous extraction
33245 insertion of epicardial single or dual chamber pacing cardioverter-defibrillator electrodes by thoracotomy
33246 with insertion of pulse generator
33249 insertion or repositioning of electrode lead(s) for single or dual chamber pacing cardioverter-defibrillator and insertion of pulse generator
Codes 33216 (insertion or repositioning of a transvenous electrode [15 days or more after initial insertion]; single chamber [one electrode] permanent pacemaker or single chamber pacing cardioverter-defibrillator) and 33217 (insertion or repositioning of a transvenous electrode [15 days or more after initial insertion]; dual chamber [two electrodes] permanent pacemaker or dual chamber pacing cardioverter-defibrillator) have also been revised, and now apply both to pacemakers and ICDs. They are used for insertion of electrodes more than 15 days after a pulse generator is implanted.
Note: Codes 33243 and 33244 differ only in the method used to remove the electrodes. In 33243, a thoracotomy is performed so the epicardial leads (on the muscle of the heart) can be removed. With 33244, the electrodes are removed by transvenous extraction, which is more commonly used and does not require a thoracotomy.
Codes 33240-33249 are not bundled into each other, so when an ICD or one of its components is removed and/or replaced, [...]
