Cardiology Coding Alert

NCCI version 9.2 edits, effective July 1, establish a one-day wait period for repositioning pacemaker and defibrillator leads - a wait that many thought was completely eliminated in CPT 2003. 

Last year, coders had to wait 15 days or more to bill for lead repositioning. The repositioning codes new to CPT 2003, 33215 (Repositioning of previously implanted transvenous pacemaker or pacing cardioverter-defibrillator [right atrial or right ventricular] electrode) for right atrial or right ventricular electrode lead repositioning and 33226 for left ventricular lead repositioning, do not have any "wait period" included in their definitions. 

So, where does the one-day wait period come from?  The version 9.2 edits list 33215 as "mutually exclusive" (not billable with) 33206, 33207, 33208, 33214, 33216, 33217, 33234, 33235 and 33249 - the codes for insertion of pacing and/or defibrillation systems and the electrode insertion and removal codes. Put simply, the edits indicate that you should not bill 33215 when the cardiologist repositions a right atrial or right ventricular electrode lead on the same day as lead or generator implantation, coding experts say.

The edits list 33226, the new coronary sinus lead repositioning code, as mutually exclusive of the codes for insertion of pacing and/or defibrillation systems and the electrode insertion and removal (see list above), as well as 33211 for temporary dual-chamber pacemaker insertion, 33212 for insertion or replacement of a single-chamber pacemaker pulse generator, 33213 for dual-chamber pulse generator insertion or replacement, and electrode repair codes 33218 and 33220.  These edits establish a one-day wait period, as well, coding specialists say.

The edits for codes 33215 and 33226 have a "0" modifier indicator, which means that you cannot append a modifier, such as modifier -59 (Distinct procedural service) to override the edit. 

The "0" indicator for these edits raises questions, coders say. There are procedures in CPT's surgical section that you may append modifier -78 to and bill when a patient returns to the operating room for a complication, regardless of the date of service. So why should pacer or lead repositioning guidelines be different? asks Nancy Reading, RN, BS, CPC, president elect of the American Association of Professional Coders (AAPC) and staff educator with University Medical Billing at the University of Utah.

"If the lead is in a bad position and is not capturing, then a patient in third-degree heart block will be beyond the benefits of a replacement pacer or cardioverter defibrillator if they are to wait one day," Reading says.  Left Ventricular Leads Have Selective Components Codes 33224 and 33225 for left ventricular (LV) lead implantation now include as components the codes for venous selective catheter placement, first-order vessel (36011) and second-order vessel (36012), as well as the code for sinus [...]