Cardiology Coding Alert

Question: How should I code the following services from a single operative note? Incision along deltopectoral groove Pacer pocket created Guidewires advanced in the left subclavian via pacer pocket (modified Seldinger) Ventricular pacer defibrillator lead advanced to the right ventricle and fixated (threshold parameters documented) Right atrial lead fixated in right atrium (threshold parameters documented) Leads attached to Teligen ICD Device placed in pocket and pocket closed

Indiana Subscriber

Answer: One code describes all of these services: 33249 (Insertion or repositioning of electrode lead[s] for single- or dualchamber pacing cardioverter-defibrillator and insertion of pulse generator).

Watch for: If you have additional documentation that the cardiologist provided fluoroscopy, remember to report 71090-26 (Insertion pacemaker, fluoroscopy and radiography, radiological supervision and interpretation; professional component).

And if the cardiologist performs an evaluation, you can report one of the following two codes at the time of an AICD insertion:

• 93640-26 -- Electrophysiologic evaluation of singleor dual-chamber pacing cardioverter-defibrillator leads including defibrillation threshold evaluation (induction of arrhythmia, evaluation of sensing and pacing for arrhythmia termination) at time of initial implantation or replacement
• 93641-26 -- ... with testing of single- or dual-chamber pacing cardioverter-defibrillator pulse generator.

How to choose: When you use 93640, that means your cardiologist performs the EP evaluation of the AICD leads before he connects them to the pulse generator. Code 93641 represents the cardiologist testing the entire system once he connects the pulse generator.