Cardiology Coding Alert

Question: The cardiologist created an incision at the selected site and inserted the electrode catheter through a vein. The cardiologist used imaging guidance to guide the electrode catheter to the right atrium. She inserted one lead and attached the lead to the pulse generator, which she implanted into a pocket that she created under the patient’s clavicle. The cardiologist evaluated and programmed the pacemaker. However, later that afternoon, the cardiologist had to revise the skin pocket by incising and draining a hematoma. Which codes would I report for this? I think I should report a revision code, but a colleague mentioned a relocation code. And another colleague said to report a revision code, but the I&D was included in the service. I am so confused. Can you help me?

Florida Subscriber

Answer: You should report 10140 (Incision and drainage of hematoma, seroma or fluid collection) for this scenario.

Don’t miss: According to the CPT^® guidelines, the revision of a skin pocket is included in codes 33206-33249, 33262-33264, and 33270-33273, when performed during the same session. However, you can report 10140, 10180, 11042-11047 for the revision of a skin pocket if it includes I&D of a hematoma or a complex wound infection. So, since your cardiologist incised and drained a hematoma without actually relocating the pocket, you should report 10140.

Your colleague mentioned a relocation of a skin pocket code like 33222 (Relocation of skin pocket for pacemaker). However, in your scenario, this is not the appropriate code because the cardiologist revised the existing pocket. The cardiologist did not move/relocate the existing pocket or create a new one.

Code 33222: With a 33222 service, the cardiologist must relocate the skin pocket for a pacemaker for situations like infection or erosion. The cardiologist preps the sites of the current and planned pockets. The cardiologist cuts away scar tissue from the pacer and leads. The cardiologist tests the leads and inspects the site and pacer. Then the cardiologist makes an incision in the patient’s upper abdominal wall, to create a new pocket for the pacer. The cardiologist connects the leads to the generator and places it in the new pocket, which she closes. The cardiologist then addresses the old pocket to prevent infection and ensure healing.

“Relocation of an existing pulse generator may be performed as a stand-alone procedure or at the time of a pulse generator or electrode insertion, replacement, or repositioning,” according to CPT^®. “When skin pocket relocation is performed as part of an explant of an existing generator followed by replacement with a new generator, the pocket relocation is reported separately.” Note: If the cardiologist performs skin pocket relocation, this service includes all of the work associated with the original pocket, along with creating the new pocket.