Cardiology Coding Alert

Question: The cardiologist implanted an internal cardioverter-defibrillator (ICD) (33249, Insertion or repositioning of electrode lead[s] for single or dual chamber pacing cardioverter-defibrillator and insertion of pulse generator). Three days later, he tested and reprogrammed the device. Is there a 14-day waiting period before we can bill for testing and reprogramming?

Maryland Subscriber

Answer: Follow-up for an ICD or pacemaker implant can refer to one of three services: complications/wound repair, repositioning and placement, and testing/ reprogramming. The requirements for each of these are different:

Any complication involving the site of the implantation, such as infection of the wound, is subject to the original procedure's surgical package, which includes a 90-day global period. Unless the complication requires a return to the operating room, the service is included and should not be reported separately.

The CPT codes for repositioning or reinserting an ICD or pacemaker should be used when these services are performed 15 or more days after the original insertion. Neither 33216 (Insertion or repositioning of a transvenous electrode [15 days or more after initial insertion]; single chamber [one electrode] permanent pacemaker or single chamber pacing cardioverter-defibrillator) nor 33217 ( dual chamber [two electrodes] permanent pacemaker or dual chamber pacing cardioverter-defibrillator) should be reported if the repositioning occurs in the first 14 days after the original insertion.

Neither the insertion's global period nor the 14-day waiting period applies to ICD checks or reprogramming. Therefore, 93642 (Electrophysiologic evaluation of single or dual chamber pacing cardioverter-defibrillator ...) may be billed separately at any time after the original insertion.