Cardiology Coding Alert

Question: The cardiologist implanted a new permanent dual chamber defibrillator system with transvenous leads. To do this, he first made an incision at the selected site and placed a pulse generator in a newly created pocket. The cardiologist threaded a catheter through a vein. He inserted the leads through the catheter and placed the electrode leads in the right ventricle and atrium. Once he placed the leads, the cardiologist attached the leads to the pulse generator in the prepared pocket and evaluated the functioning of the system. After checking for bleeding, the cardiologist removed all of the instruments and closed the incision in the patient’s chest. Which code should we report for this procedure?

Wisconsin Subscriber

Answer: You should report 33249 (Insertion or replacement of permanent implantable defibrillator system, with transvenous lead(s), single or dual chamber) for this procedure.

You should never report 33216 (Insertion of a single transvenous electrode, permanent pacemaker or implantable defibrillator) or 33217 (Insertion of 2 transvenous electrodes, permanent pacemaker or implantable defibrillator) in conjunction with 33249, according to CPT^®.

Reminder: Do not forget to apply modifier Q0 (Investigational clinical service provided in a clinical research study that is in an approved clinical research study) or Q1 (Routine clinical service provided in a clinical research study that is in an approved clinical research study) when appropriate, according to the NCD 20.4 and CMS Change Request (CR) 5805.