Cardiology Coding Alert

In other words, you'll code the generator removal with 33241 and generator replacement with 33240, Fuller says. 

And if the doctor performs an EP evaluation of the system (including arrhythmia induction), make sure to include 93641, says Patricia Gajewski, CPC, a full-time coder at Consultants in Cardiovascular Disease Inc. in Erie, Pa.

Don't miss: If you're reporting these codes together for a non-Medicare patient, you'll most likely need to append modifier 51 (Multiple procedures) to 33241 (removal of ICD only) and also append modifier 26 (Professional component). For Medicare patient, you'll still include modifier 26 on 33241.

If your cardiologist inserted the ICD for a non-arrhythmia diagnosis (such as, for MADIT II or SCD-HeFT patients) and the patient has Medicare, you should be sure to add modifier QR, Fuller says. Medicare patients who receive an ICD or replacement ICD as a primary prevention of sudden cardiac death must be enrolled in a data collection system. Otherwise, Medicare may not cover the procedure. Adding modifier QR to your claim will signify the patient's enrollment in the registry.
Keep in mind: If the cardiologist upgrades a dual- chamber ICD to a biventricular ICD, you should use the same codes with the same modifiers but add +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]).

Strike Out Other CPT Possibilities

You may or may not have to report ICD lead replacement, fluoroscopy or skin pocket revision codes, so you'll have to dig into your cardiologist's note to decide.

Leads: Most often, the cardiologist won't need to replace the leads, but if he does, you should report the removal of an electrode using 33244 (Removal of single- or dual-chamber pacing cardioverter-defibrillator electrode[s]; by transvenous extraction).
 
If the cardiologist replaces a generator and at least one lead, you should report the implantation of a new system (33249, Insertion or repositioning of electrode lead[s] for single- or dual-chamber pacing cardioverter-defibrillator and insertion of pulse generator). Keep in mind: You should report 33249 in addition to the appropriate removal code(s), fluoroscopy and EP evaluation of the device.

Fluoroscopy: You won't have to include a fluoroscopy code (such as 71090, Insertion pacemaker, fluoroscopy and radiography, radiological supervision and interpretation) unless, after testing the ICD (93641), the cardiologist discovered a problem. In this case, he may conduct a fluoroscopic examination of the implanted system to evaluate the problem. But make sure the cardiologist's note indicates that he used fluoroscopy.

Skin pocket revision: Most likely, you're not going to report a pocket revision (33223-59, Revision of skin pocket for single- or dual-chamber pacing cardioverter-defibrillator; distinct procedural service) with this scenario. But when the cardiologist needs to make the pocket bigger or has to move the pocket to the right side of the chest or abdominal area, you may need to include 33223, Gajewski says.

Add 'Recall' to Your Comment Field

To make sure your claim is complete, our experts recommend taking the following steps.

Don't be stingy when it comes to including extra information. "The best advice I can give when coding ICD replacement, especially with all the recalls, is to make sure you're sending in all of the documentation available - including procedures, echos, stress, etc.," Gajewski says.

Also, in the comment "local use field" section of your claim, you may want to include the phrase "[Company name] recall." This will inform the patient's payer why your cardiologist is replacing the device. The payer will then go to the device manufacturer for reimbursement after they pay the providers and facilities, Fuller says.