Physician Reimbursement Primer for Cardiac ... - Boston Scientific
Physician Reimbursement Primer for Cardiac ... - Boston Scientific
Physician Reimbursement Primer for Cardiac ... - Boston Scientific
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Chapter 5<br />
• Disconnection of leads, reconnection of leads, reprogramming of parameters, and<br />
testing of the leads and pulse generator are included in the codes.<br />
• In the unusual circumstance that the leads have been placed without a pulse<br />
generator, report codes 33216 or 33217 as appropriate <strong>for</strong> the insertion, with code<br />
33234 or 33235, as appropriate, <strong>for</strong> the removal of previously placed leads.<br />
Pacemaker Generator Upgrade (33214)<br />
33214 Upgrade of implanted pacemaker system, conversion of single-chamber system<br />
to dual chamber system (includes removal of previously placed pulse generator,<br />
testing of existing lead, insertion of new lead, insertion of new pulse generator)<br />
Documentation and Billing Tips<br />
• The removal of the existing pacemaker generator is included with code 33214 and<br />
should not be coded separately.<br />
• Disconnection of leads, reconnection of leads, reprogramming of parameters, and<br />
testing of the leads and pulse generator are included in the codes.<br />
• If fluoroscopic guidance is documented, report code 71090. Assign modifier 26 to<br />
describe the professional component of services provided that are hospital-based.<br />
Check with individual payers regarding separate payment <strong>for</strong> 71090, as some payers<br />
may consider this bundled into the device-implant code.<br />
Pacemaker Removal (33233)<br />
33233 Removal of permanent pacemaker pulse generator<br />
Documentation and Billing Tips<br />
• Do not code separately if the pacemaker generator is upgraded from a single to a<br />
dual-chamber system (code 33214 includes removal of device).<br />
• Disconnection of leads, reconnection of leads, reprogramming of parameters, and<br />
testing of the leads and pulse generator are included in the codes.<br />
• Code separately <strong>for</strong> the replacement of a new pacemaker generator (33212 or<br />
33213).<br />
• Code separately <strong>for</strong> the extraction of the leads (33234 or 33235).<br />
• If a lead is capped or removed (33234 or 33235) and a new lead is inserted in<br />
addition to replacing the pulse generator, report the procedure with code 33206–<br />
33208 as appropriate.<br />
• If a full and complete diagnostic subclavian venogram is per<strong>for</strong>med (medical<br />
necessity established, images obtained and findings documented), report it<br />
separately with codes 36005 and 75820. Code 36005 may need a 59 modifier<br />
attached. If subclavian venogram is per<strong>for</strong>med to determine vein patency or <strong>for</strong> roadmapping<br />
purposes, code 75820 and 36005 should not be billed.<br />
Pacemaker Lead (Electrode) Insertion (33216, 33217)<br />
33216 Insertion of a transvenous electrode; single-chamber (one electrode), permanent<br />
pacemaker or single-chamber pacing cardioverter-defibrillator<br />
33217 Insertion of a transvenous electrode; dual chamber (two electrodes) permanent<br />
pacemaker or dual chamber pacing cardioverter-defibrillator<br />
Documentation and Billing Tips<br />
• If a full and complete diagnostic subclavian venogram is per<strong>for</strong>med (medical<br />
necessity established, images obtained and findings documented), report it<br />
separately with codes 36005 and 75820. Code 36005 may need a 59 modifier<br />
26 <strong>Physician</strong> <strong>Reimbursement</strong> <strong>Primer</strong> <strong>for</strong> <strong>Cardiac</strong> Rhythm Management