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Cardiology Coding Alert

You Be The Coder - Replacing Dual Pacer Generator and Atrial Lead

Published on Mon Feb 16, 2004

Question: Our physician recently replaced a generator on a dual system pacemaker for end of life and replaced the atrial lead because it was malfunctioning. One person in my office thinks we should just bill 33214, and the other thinks we should report 33233 (Removal of permanent pacemaker pulse generator), 33213 (Insertion or replacement of pacemaker pulse generator; dual chamber) and 33216 (Insertion of a transvenous electrode ...). What would you advise? 

Colorado Subscriber


Answer: You may be tempted to use 33214 (Upgrade of implanted pacemaker system, conversion of single-chamber system to dual-chamber system [includes removal of previously placed pulse generator, testing of existing lead, insertion of new lead, insertion of new pulse generator]), but the AMA suggests otherwise. The AMA gave the following guidance in 2003 for the situation you describe: You should use "code 33233 (Removal of permanent pacemaker pulse generator) ... for the removal of the existing pulse generator."

Moreover, the AMA advises that when the physician removes "the old atrial electrode," you may report this separately with code 33235 (Removal of transvenous pacemaker electrode[s]; dual-lead system). If the physician replaces both the generator and the atrial electrode, you should report 33206 (Insertion or replacement of permanent pacemaker with transvenous electrode[s]; atrial). The AMA further instructs that you should use "code 71090 (Insertion pacemaker, fluoroscopy and radiography, radiological supervision and interpretation) for the radiological supervision and interpretation portion of the procedure."

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