Cardiology Coding Alert

Whether lower-end or advanced devices, you'll still use 33249

Reimbursement is likely to be a little easier for implantable cardioverter defibrillator (ICD) procedures such as 33249, now that Medicare covers 25,000 more beneficiaries who require ICDs this year. However, you'll need to make sure you meet the requirements for medical necessity - especially for more advanced devices.
 
CMS announced a draft plan to expand coverage of ICDs, which should increase the number of eligible beneficiaries by a third, to almost half a million.
 
Note: Keep in mind that Medicare's ICD policy has not been finalized or implemented.

SCD-HeFT Broadens CMS Coverage

 
Physicians implant ICDs into patients' chests to monitor the heart's rhythm and deliver a shock when they detect an arrhythmia. New clinical studies show that patients who have never had a heart attack can benefit from ICDs, so CMS recommended expanding coverage to a broader population, including patients with heart failure and poor function of their left ventricle. Also, patients with a "narrow QRS" finding on electrocardiograms of the heart can benefit from the devices, CMS says.
 
"Based on the Sudden Cardiac Death in Heart Failure Trial (SCD-HeFT) results, we were pleased that CMS provided positive consideration," says Barb Veath, CPC, senior reimbursement manager for Medtronic Inc. in Minneapolis, Minn.
 
"We commend CMS on the high quality of their careful review ... and applaud the decision to extend coverage for patients with coronary artery disease and to include those who have nonischemic cardiomyopathy," says the Heart Rhythm Society (HRS) and the American College of Cardiology (ACC) in a letter to CMS.

Guidelines Provide Lower-End Devices

Medicare said patients who qualify for the device under the new guidelines may receive a lower-end, shock-only device - unless cardiologists show that a more advanced device is medically necessary. "Medicare has asked physicians to document their choice of device and exhibit a preference for simpler, less costly devices. No restriction has been placed on a device choice in the policy," Veath says.
 
Either way, this may not impact coding the implant of the ICD, because you would use the same code for a single- or dual-chamber device (33249, Insertion or repositioning of electrode lead[s] for single- or dual- chamber pacing cardioverter-defibrillator and insertion of pulse generator).
 
Important: The draft guidelines do not restrict the type of device that Medicare will cover initially, says Jim Collins, ACS-CA, CHCC, CPC, chief executive office of the Cardiology Coalition in Matthews, N.C. "They appear to be collecting data to see if single-lead, shock-only defibrillators (frequently called 'shock boxes') are sufficient to obtain the benefits outlined in the trial."
 
What this means to you: Your cardiologist may need to justify the medical necessity for a device that is more complex than a single-lead, shock-only system. Some    top-of-the-line devices not only shock errant heartbeats back into rhythm but also work as pacemakers and facilitate cardiac resynchronization. 

Prepare for a Nation-Wide Registry

In the current draft, CMS also linked the broadened reimbursement to a system that tracks patients getting the devices. The registry is to be set up by Jan. 1, 2005 - a date that the HRS and ACC hope to extend because of infrastructure and money issues.