Cardiology Coding Alert

Question: What exactly does a pacemaker consist of? I have a dual chamber permanent pacemaker insertion. Should I code 33208, 33225 and 71090-26 when the cardiologist visualized the entire implant under fluoroscopy?

Kentucky Subscriber Answer: You'll report pacemakers based on the number of right-sided heart chambers that have a pacing lead implanted in them. 

If your cardiologist inserts a generator with a right atrial lead, you'll report 33206 (Insertion or replacement of permanent pacemaker with transvenous electrode[s]; atrial).

If he places a generator with only a right ventricular lead, then you should report 33207 (Insertion or replacement of pacemaker with transvenous electrode[s]; ventricular).

And report 33208 (Insertion or replacement of permanent pacemaker with transvenous electrode[s]; atrial and ventricular) for a generator with both right atrial and right ventricular leads.

You'll represent additional left ventricular (LV) lead insertion by +33225 (Insertion of pacing electrode, cardiac venous system, for left ventricular pacing, at time of insertion of pacing cardioverter-defibrillator or pacemaker pulse generator [including upgrade to dual-chamber system] [list separately in addition to code for primary procedure]) if the physician attaches the LV lead to a new generator.

You should 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]) if the cardiologist adds an LV lead to a previously implanted generator.

If your cardiologist places a new right atrial or right ventricular lead and attaches it to a previously implanted generator, then you should use 33216 (Insertion of a transvenous electrode; single chamber [one electrode] permanent pacemaker or single chamber pacing cardioverter-defibrillator) for a single chamber. For a dual chamber, you'll rely on 33217 (... dual chamber [two electrodes] permanent pacemaker or dual chamber pacing cardioverter-defibrillator).

Don't forget: You'll report the fluoroscopy using 71090-26 (Insertion pacemaker, fluoroscopy and radiography, radiological supervision and interpretation; professional component) only when your cardiologist documents it in the operative report.