Cardiology Coding Alert

Question: If we see a patient for pacemaker or AICD programming during the global period for implant, may we report the DFT programming or is it bundled?

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Answer: You may report defibrillation threshold test (DFT) programming services performed during the global period of the implant. While you should consider an incision check to be included in the global surgical package, you may separately report the programming required for the device.

One rationale given for this approach is that the programming requires a diagnostic evaluation, and such a diagnostic test is not covered by the global package.

For DFT on a day subsequent to implant day, report 93642 (Electrophysiologic evaluation of single or dual chamber transvenous pacing cardioverter-defibrillator [includes defibrillation threshold evaluation, induction of arrhythmia, evaluation of sensing and pacing for arrhythmia termination, and programming or reprogramming of sensing or therapeutic parameters]).

Append modifier 26 (Professional component) if you’re reporting only the professional component.

Tip: For DFT on implant day, report 93641 (Electrophysiologic evaluation of single or dual chamber pacing cardioverter-defibrillator leads including defibrillation threshold evaluation [induction of arrhythmia, evaluation of sensing and pacing for arrhythmia termination] at time of initial implantation or replacement; with testing of single or dual chamber pacing cardioverter-defibrillator pulse generator).

Coverage for this code is decided by the carrier, and Medicare provides suggested RVUs for only the professional component.