ED Coding and Reimbursement Alert

Investigate This Little Known Procedure To See If Should Be Added To Your Charge Master

If you have a patient with a pacemaker reporting to the ED complaining of heart problems, you may need to verify the pacemaker is functioning properly.

Patients with a previously implanted device, such as a cardiac pacemaker, implantable cardioverter-defibrillator (ICD), implantable cardiovascular monitor (ICM), or implantable loop recorder (ILR), require periodic interrogation device evaluationssays Michael A. Granovsky, MD, FACEP, CPC, President of Logix Health, an ED coding and billing company in Bedford, MA. This diagnostic procedure includes a face-to-face assessment of all device functions.

Components that must be evaluated in order to assign  CPT^® code 93288 (Interrogation device evaluation [in person] with analysis, review and report by a physician or other qualified health care professional, includes connection, recording and disconnection per patient encounter; single, dual, or multiple lead pacemaker system) includesan evaluation of the battery, lead(s), capture and sensing function, heart rhythm, and programmed parameters of a single-, dual-, or multiple-lead pacemaker system. Code 93289 (Interrogation device evaluation [in person] with analysis, review and report by a physician or other qualified health care professional, includes connection, recording and disconnection per patient encounter; single, dual, or multiple lead implantable cardioverter-defibrillator system, including analysis of heart rhythm derived data elements)requires evaluation of the battery, lead(s), capture and sensing function, heart rhythm derived elements, presence or absence of therapy for ventricular tachyarrhythmias, and programmed parameters of a single-, dual-, or multiple-lead ICD system.

Code 93288 is the correct code for the typical interrogation, but use 93289 if they specifically mention it is a pacemaker defibrillator automated implantable cardioverter defibrillator (AICD), Granovsky explains.

Review These Sample Notes for Proper Coding

Granovsky provides these examples to guide your pacemaker reporting:

Sample documentation:I have discussed the planned procedure with the patient including alternative therapy including benefits and risks. The patient understands the planned procedure and agrees to have it performed. I performed interrogation of AICD. The patient denies feeling that the unit has discharged and is agreeable to interrogation in the ED. The unit was interrogated with a portable device and uploaded.No tenderness at the site. Tracing was analyzed by myself and the case was discussed with the Medtronics rep. Recorded, persistent atrial flutter-atrial tachycardia with adequate remaining battery life and impedance is stable. No acute interventions. Duplicate report will be sent to cardiologist.

Pacemaker interrogation using the Medtronics device. The pacemaker was interrogated and the Medtronics report was reviewed. Impedance appears consistent. Threshold without acute change despite reported lead warning. This was discussed with the Medtronics rep who concurs. Additional report also sent to primary care physician. Battery has several years of remaining life. No other acute issues identified. No high or low rate warnings received.

What to report: Since no mention of AICD is in either example, both would be reported using code 93288.

The payment for the service is not high, but Medicare should pay about $ 37 and $64 based on the assigned facility RVUs and current Conversion Factor of $34.0230, says Granovsky.