Cardiology Coding Alert

Question: After the patient was appropriately prepped and anesthetized, the physician created an incision at the selected site. Since a previously implanted defibrillator system was present, they opened the pocket and disconnected the leads so that they could replace the generator. The physician then threaded a catheter through a vein. They used fluoroscopy to guide the electrode catheter to the appropriate heart chambers. Next, the physician inserted the leads through the catheter and placed the electrode leads in the desired heart chambers. This was a dual chamber system, so they placed a lead in the right ventricle and atrium. Once the leads were placed in the chambers of the heart, the physician attached the leads to the pulse generator in the prepared pocket and evaluated system’s function. Finally, they checked for bleeding, removed all instruments, and closed the incision in the patient’s chest. How should I report this scenario?

North Dakota Subscriber

Answer: You should report 33249 (Insertion or replacement of permanent implantable defibrillator system, with transvenous lead(s), single or dual chamber) on your claim. You can report this code for either a single or dual chamber system, according to the code descriptor. According to the information provided, your physician noted that this was a dual lead system, which means the pacing and sensing functions are in only two chambers of the heart.

Don’t miss: Never report 33249 in conjunction with electrode insertion codes 33216 or 33217, per CPT^®.

Coding tip: Revision of a skin pocket is included in 33249, according to CPT^®. However, when the revision of a skin pocket involves incision and drainage (I&D) of a hematoma or complex wound infection, you can report I&D codes 10140 and 10180 and debridement codes 11042 through +11047 as appropriate.