Cardiology Coding Alert

Question: I have a denial for codes 33227 and 33216-59 where 33227 is being denied as “Not covered when performed during the same session/date as a previously processed service for the patient.” Any advice on why this is happening?

North Carolina Subscriber

Answer: You will find a National Correct Coding Initiative (NCCI) procedure-to-procedure (PTP) edit between 33227 (Removal of permanent pacemaker pulse generator with replacement of pacemaker pulse generator; single lead system) and 33216 (Insertion of a single transvenous electrode, permanent pacemaker or implantable defibrillator). Code 33227 is a column 2 code for 33216, which means that 33227 is bundled into 33216. Since the modifier indicator for this edit is “0,” you cannot override the edit under any circumstance.

Don’t miss: Also, if you look in the CPT^® manual, a rule tells you never to report 33216 in conjunction with the following codes:

• 33206 (Insertion of new or replacement of permanent pacemaker with transvenous electrode(s); atrial)-33208 (… atrial and ventricular)
• 33212 (Insertion of pacemaker pulse generator only; with existing single lead)-33214 (… with existing multiple leads)
• 33221 (Insertion of pacemaker pulse generator only; with existing multiple leads)
• 33227 (Removal of permanent pacemaker pulse generator with replacement of pacemaker pulse generator; single lead system)-33231 (Insertion of implantable defibrillator pulse generator only; with existing multiple leads)
• 33240 (Insertion of implantable defibrillator pulse generator only; with existing single lead)
• 33249 (Insertion or replacement of permanent implantable defibrillator system, with transvenous lead(s), single or dual chamber)
• 33262 (Removal of implantable defibrillator pulse generator with replacement of implantable defibrillator pulse generator; single lead system)-33264 (… multiple lead system)