Cardiology Coding Alert

Answer: Overdrive pacing (pacing above the basal rate) may be used on patients with recurrent ventricular tachycardia to terminate ventricular arrhythmia.

The use of a previously implanted pacemaker for pacing overdrive should be reported using unlisted procedure code 93799, says Diane Elvidge, CPC, coding specialist with Princeton Reimbursement Group in Minneapolis.

Many practices have tried to code this procedure using existing CPT codes, Elvidge says. For example, 93732 (electronic analysis of dual-chamber pacemaker system [includes evaluation of programmable parameters at rest and during activity where applicable, using electrocardiographic recording and interpretation of recordings at rest and during exercise, analysis of event markers and device response]; with reprogramming) is frequently used because after pacing overdrive is performed the device is reprogrammed.

According to Elvidge, this may be correct if all the components of the code were performed, in which case it should be reported with modifier -22 (unusual procedural services) appended. This approach is not recommended, however, because the reason the patient saw the physician is the tachycardia not for an electronic analysis with the tachycardia overdrive as a secondary issue.

Coders also may use 93642 (electrophysiologic evaluation of single or dual chamber pacing cardioverter-defibrillator [includes defibrillation threshold evaluation, induction of arrhythmia, evaluation of sensing and pacing for arrhythmia termination, and programming or reprogramming of sensing or therapeutic parameters]). Although this code does describe induction of arrhythmia, it refers to an implantable cardioverter-defibrillator rather than a pacemaker.

Code 93610 (intra-atrial pacing) also should not be used because it describes an invasive procedure that involves a right heart catheterization, which did not occur.

Many carriers have specific medical-necessity requirements for coverage of this procedure. For example, Empire Medicare Services, the Part B carrier in New Jersey and parts of New York, categorizes overdrive pacing in response to recurrent and refractory ventricular tachycardia as a group II condition, meaning it may be deemed covered if the documentation supports the need for the service.

A diagnosis code that indicates the medical necessity for the procedure (for example, 427.1, paroxysmal ventricular tachycardia) should be included on the claim form when appropriate.