Cardiology Coding Alert

Steer clear of these codes when patient presents to swap the old battery for a new one.

CPT® 2012 brings code changes, revised guidelines, and new definitions to the Pacemaker and Pacing Cardioverter-Defibrillator section. Cardiology Coding Alert is taking the code changes one step at a time, with this article focusing on pacemaker (PM) pulse generator insertion codes 33212, 33213, and 33221.

Get started: One important change to keep in mind is that radiological supervision and imaging is now included in PM and pacing cardioverter-defibrillator codes 33206-33249, as was stressed in the Cardiology Services Update by Kenneth P. Brin, MD, PhD, FACC, of the CPT® Editorial Panel, and James Blankenship, MD, MACC, FSCAI, of the Relative Value Update Committee, at the CPT® and RBRVS 2012 Annual Symposium.

Get a Quick View of Revisions and Additions

CPT® 2012 revises the definitions of 33212 and 33213 as shown below, effective Jan. 1, 2012:

CPT® 2012 also adds a third code to this family:

• 33221, ... with existing multiple leads.

'Replacement' Removal Is Key Change

The codes' first change of note is the deletion of "or replacement" from the common portion of the definition shared by 33212, 33213, and (in 2012) 33221.

Removing "replacement" makes way for the addition of three new codes that you should use in 2012 when the physician removes a PM pulse generator (battery) and replaces the battery at the same session:

• 33227, Removal of permanent pacemaker pulse generator with replacement of pacemaker pulse generator; single lead system
• 33228, ... dual lead system
• 33229, ... multiple lead system.

Compare 2011 to 2012: As an example of how these changes affect coding, remember that in 2011 you reported a single-chamber PM generator change using 2011 codes 33233 (Removal of permanent pacemaker pulse generator) for the removal of a battery and 33212 for replacing a battery at the same session. In 2012, you instead should report 33227 to capture both the removal and the replacement.

Consequently, in 2012, you'll report 33212, 33213, and 33221 only when a patient who already has electrodes (leads) in place presents just for insertion of the PM pulse generator. You should no longer use 33212, 33213, or 33221 combined with 33233 for a battery change. To further emphasize this change, 33233 has a revised definition in 2012, adding the term "only" at the end: Removal of permanent pacemaker pulse generator only. This means that 33233 is a stand-alone code.

Helpful instruction: A parenthetical note with the codes ensures you understand that 33212, 33213, and 33221 are not appropriate for replacement services: "Do not report 33212, 33213, 33221 in conjunction with 33233 for removal and replacement of the pacemaker pulse generator. Use 33227-33229, as appropriate, when pulse generator replacement is indicated."

Check Guideline for Multiple Lead Definition

The second change to the pulse generator insertion code definitions is to the portion unique to each code. In 2011, the codes referred to single chamber (33212) or dual chamber (33213). In 2012, the codes instead refer to existing single lead (33212), existing dual leads (33213), and existing multiple leads (33221).

CPT® guidelines instruct that "single lead" means a PM with pacing and sensing function in only one heart chamber. "Dual lead" indicates pacing and sensing function in two heart chambers. "Multiple lead" refers to pacing and sensing function in more than two heart chambers.

33221 Reveals How Resequencing Works

Locating 33221 in your manual can be confusing at first glance. The manual places new code 33221 out of numerical order between 33213 and 33214 (Upgrade of implanted pacemaker system ...).

The pound symbol (#) or hash mark with 33221 indicates the code has purposely been placed out of numerical order. The reason is that the AMA decided in 2010 that this method prevented the need to completely renumber existing codes to accommodate a new code in a code family.

If you look after 33220 (Repair of 2 transvenous electrodes ...) in the manual, you'll see 33221 with a note that the code is out of numerical sequence. Unfortunately, the only guide to tell you where to find the code is "See 33202-33249." To simplify the search, you may want to make a note or otherwise mark that 33221 with its definition is located under 33213.