Cardiology Coding Alert

New Pacemaker Codes Cross The Finish Line for Use in 2003 CPT 2003, which goes into effect Jan. 1, brings substantial changes for the cardiology coder, including three new codes and one revised code that will alter the way you report the insertion and repositioning of pacemaker and pacing cardioverter-defibrillator systems.

In addition, the 2003 version has two new codes for septal defect closure and some wording changes that will affect the way you apply existing codes. New Electrode Codes Spark Billing Change CPT 2003 adds two new codes for repositioning previously implanted pacemaker electrodes and makes a major change to the time frame for billing for electrode insertion. The two new codes for repositioning previously implanted electrodes include: 33215 Repositioning of previously implanted transvenous pacemaker or pacing cardioverter-defibrillator (right atrial or right ventricular) electrode 33226 Repositioning of previously implanted cardiac venous system (left ventricular) electrode (including removal, insertion and/or replacement of generator). You should use 33215 for repositioning the right ventricular or right atrial electrodes and 33226 for repositioning the cardiac venous electrode, advises Nikki Vendegna, CPC, a cardiology coding and reimbursement specialist in Overland Park, Kan. But theres even bigger news for cardiology coders in a revision to 33216, which will allow you to bill for repositioning electrodes within 14 days. This is a major change, Vendegna stresses. Prior to the revision, you could not bill for electrode repositioning until 15 days after insertion. The revised description in CPT 2003 states: 33216 Insertion of a transvenous electrode; single chamber (one electrode) permanent pacemaker or single chamber pacing cardioverter-defibrillator. In addition to deleting the phrase "15 days or more after initial insertion" from the 2002 version, the new version of 33216 also deletes "repositioning" in reference to transvenous electrode placement.

In turn, the deletion of "repositioning" in 33216 also removes the term from its companion code 33217 (dual chamber [two electrodes] permanent pacemaker or dual chamber pacing cardioverter-defibrillator), which covers dual chamber electrode placement. What this means is that you should use 33216 and 33217 just for insertion and not for repositioning, which is new, Vendegna instructs. Upgraded Devices Get Stand-Alone Code Starting in January, when cardiologists add bi-ventricular pacing capability to existing pacemakers and defibrillators, coders can use 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]), a new code specifically for such pacemaker system overhauls. New text inserted in the CPT 2003 pacemaker section states that in certain circumstances, "an additional electrode may be required to achieve pacing of the left ventricle (bi-ventricular pacing)." In these situations, "transvenous (cardiac vein) placement of the [...]