Cardiology Coding Alert

Question: How should I report a RV PPM upgrade to a BIV that was aborted due to anatomy? This was just the addition of a CS lead. No RA lead was added. Code +33225 is an add-on code, so I can’t just bill that code alone and modify as aborted. Which code should I report?

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Answer: You should report 33224 (Insertion of pacing electrode, cardiac venous system, for left ventricular pacing, with attachment to previously placed pacemaker or implantable defibrillator pulse generator (including revision of pocket, removal, insertion, and/or replacement of existing generator)). Attach modifier 53 (Discontinued procedure) on your claim to indicate the procedure was discontinued after anesthesia.

If biventricular pacing is required, your cardiologist will place an additional electrode in the left ventricle. With the pacemaker or implantable defibrillator already in place, your cardiologist gains access transvenously through the subclavian or jugular vein. They will perform this procedure under local anesthesia. They may use a fluoroscope for guidance and will insert a pacing electrode in the left ventricular chamber of the heart, usually in the coronary sinus tributary. Your cardiologist will connect the electrode to the pulse generator and then close the pocket.