Cardiology Coding Alert

Question: A patient came in for permanent dualchamber generator removal and placement of a new one. The physician also repaired a single lead in the same session. Which codes should I report for the removal, placement, and repair?

Ohio Subscriber

Answer: You may report each service separately.

CPT guidelines for “Pacemaker or Pacing Cardioverter-Defibrillator” state “replacement of a pulse generator should be reported with a code for removal of the pulse generator and another code for insertion of a pulse generator.”

Helpful: You may hear providers refer to replacing the pulse generator as a battery change, a generator       change, or a “gen” change.

Removal: Code 33233 (Removal of permanent pacemaker pulse generator) describes the removal of the pulse generator.

Insertion: Use 33213 (Insertion or replacement of pacemaker pulse generator only; dual chamber) for the placement.

Repair: For the repair in your scenario -- one lead of a dual-chamber system -- you should report 33220

(Repair of two transvenous electrodes for a dual chamber permanent pacemaker or dual chamber pacing cardioverter-defibrillator). Some experts recommend appending modifier 52 (Reduced services) to alert the payer that the cardiologist did not perform the full service described by the code. The advice to report 33220-52 matches a coding tip in the AMA’s Principles of CPT Coding, fourth edition, which states, “The appropriate method for reporting the repair of only one transvenous electrode for a dual-chamber device is to append modifier 52, Reduced Services, to code 33220.

Don’t be tempted to use 33218 (Repair of single transvenous electrode for a single chamber, permanent pacemaker or single chamber pacing cardioverterdefibrillator). Although this code is for single lead repair, it only applies to single chamber systems, and your cardiologist repaired a single lead in a dual chamber system.

Term tip: CPT guidelines state that “lead” is another term for “electrode” and a “dual chamber pacemaker system includes a pulse generator and one electrode inserted in the right atrium and one electrode inserted in the right ventricle.”