Wiki Pacemaker question - answer for possible publication

[lvillers]

Coders,

"For the Record" magazine has asked us a coding question. The answer may quite possibly be published in their magazine, so we thought we would give you all a chance to answer.

Question: "When coding replacement of pacemaker generator, the notes say two codes are needed; one for the removal and one for the replacement. I have two coding cases for replacement of pacemaker generator. They both say 33213 only is the correct code. I don't understand why a second code is not needed since the notes in the coding manual state two codes are needed."

Know that your answer could end up in the magazine - we may contact you once the "final" answer is selected to receive your permission.

Thank you!

 

[dmaec]

without reading the notes for each visit - I'd have to assume that the reason the 33213 (alone) is being coded/billed - is because the insertion/generator 33213 service and the insertion/lead service 33202/33203 were not done by the same physician/same session;(as the note states they have to be in order to be billed together)

Perhaps the the epicardial lead placement was done by a different physician?

but, again, we'd need to see the documentation to be certain.

 

[ciphermed]

One code is needed for the removal of the pulse generator and another code is needed for the insertion of the new generator. As per the AMA, the word replacement in the CPT descriptor (33212) is not meant to imply that the removal of the existing device is included in aforementioned code.

Addressed by the AMA in 1994 & 2004 via CPT Assistants

Hope this helps,