Cardiology Coding Alert

Question: We have a patient who had a dual-chamber pacemaker system inserted by one of our cardiologists. Four days later, the same cardiologist repositioned the ventricular lead. For this, the cardiologist had to explant the generator, test and reposition the lead, and reinsert the generator.  Should I report 33215-78? Three days after that lead revision, the same doctor had to put in a completely new lead. Should I use 33217-78 and 33235-78?

Idaho Subscriber

Answer: In the first scenario, you should report the lead repositioning using 33215 (Repositioning of previously implanted transvenous pacemaker or pacing cardioverter-defibrillator [right atrial or right ventricular] electrode) and the fluoroscopy using 71090-26 (Insertion pacemaker, fluoroscopy and radiography, radiological supervision and interpretation; professional component) - as long as you have documentation that supports these procedures.

Don't separately report the explantation of the generator and its reimplantation, because the cardiologist reused the same device.

For the second service, removal of the old electrode and implantation of a new one, you are correct to use 33217 (Insertion of a transvenous electrode; dual chamber [two electrodes] permanent pacemaker or dual chamber pacing cardioverter-defibrillator) and 33235 (Removal of transvenous pacemaker electrode[s]; dual lead system). You should also report 71090-26 (Insertion pacemaker, fluoroscopy and radiography, radiological supervision and interpretation; professional component) for the fluoroscopy.

You're also correct in appending modifier -78 (Return to the operating room for a related procedure during the postoperative period) to 33217 and 33235, although some insurers may not require this modifier.