Physician Reimbursement Primer for Cardiac ... - Boston Scientific

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Chapter 5 ICD Generator Replacement (33240) 33240 Insertion of single or dual chamber pacing cardioverter defibrillator pulse generator Documentation and Billing Tips • Report code 33240 for the replacement of a device at “end of life.” • Report codes 33249 for upgrading a single-chamber ICD to a dual-chamber system. • Report code 33241 for the removal of the existing ICD. ICD Generator Removal (33241) 33241 Subcutaneous removal of single or dual chamber pacing cardioverter-defibrillator pulse generator Documentation and Billing Tips • Disconnection of leads, reconnection of leads, and reprogramming of parameters are included in these codes. Defibrillator threshold testing of lead(s) and/or pulse generator is separately billable by codes 93640-93642. • Report code 33240 for the replacement of a device at “end of life.” • Report codes 33249 for upgrading a single-chamber ICD to a dual-chamber system. • Code separately for the extraction of the leads (33244). ICD Pacemaker Generator Lead (Electrode) Insertion (33216, 33217) 33216 Insertion of a transvenous electrode; single-chamber (one electrode), permanent pacemaker or single-chamber pacing cardioverter-defibrillator 33217 Insertion of a transvenous electrode; dual chamber (two electrodes) permanent pacemaker or dual chamber pacing cardioverter-defibrillator The insertion of one or two leads (only) by transvenous technique is usually performed because one or more leads are defective. The generator is removed and the lead disconnected. The lead may be removed or capped. The subclavian or jugular vein is accessed, and a lead is advanced into the central venous system. Fluoroscopic guidance is utilized to place the lead into the right atrium, right ventricle or both. In the unusual circumstance that only the leads are placed, without a generating device, 33216 or 33217 is the appropriate code. Documentation and Billing Tips • If a full and complete diagnostic subclavian venogram is performed (medical necessity established, images obtained and findings documented), report it separately with codes 36005 and 75820. Code 36005 may need modifier 59 attached. If subclavian venogram is performed to determine vein patency or for roadmapping purposes, code 75820 and 36005 should not be billed. • The term “repositioning” has been transferred to code 33215. • The restriction of “15 days or more” postoperative has been deleted. • Modifier 59 may be applicable, if a lead is replaced on the same day of service as previous implant. • Disconnection of leads, reconnection of leads, reprogramming of parameters, and testing of leads and pulse generator are included in these codes for pacemaker devices. For ICD or CRT-D devices, defibrillator threshold testing of lead(s) and/or pulse generator is separately billable by codes 93640–93642. 32 Physician Reimbursement Primer for Cardiac Rhythm Management
Coding Overview • Temporary pacing is not included and should be reported separately (33210 or 33211). • Extraction of a chronic lead is not included and should be reported separately (33244). • Codes 33216 and 33217 are applicable to both pacemaker generators and ICDs. • If fluoroscopic guidance is documented, report code 71090. Assign modifier 26 to describe the professional component of hospital-based services. Check with individual payers regarding separate payment for 71090, as some payers may consider this bundled into the device-implant code. ICD Pacemaker Generator Biventricular Lead (Electrode) Placement Into Cardiac Venous System (33224, 33225) 33224 Insertion of pacing electrode, cardiac venous system, for left ventricular pacing, with attachment to previously placed pacemaker or pacing cardioverterdefibrillator pulse generator (including revision of pocket, removal, insertion and/or replacement of generator) 33225 Insertion of pacing electrode, cardiac venous system, for left ventricular pacing, at time of insertion of pacing cardioverter-defibrillator or pace-maker pulse generator (including upgrade to dual chamber system) (List separately in addition to code for primary procedure) Documentation and Billing Tips • Code 33224 is reported when the lead placed within the coronary sinus is connected to an existing pacemaker generator or ICD. • Code 33225 is reported when the lead placed within the coronary sinus is connected to a new pacemaker generator or ICD. This code is also reported when the existing pacemaker generator or ICD is removed and replaced or upgraded. • Report code 33225 in addition to the primary procedure—codes 33206, 33207, 33208, 33212, 33213, 33214, 33216, 33217, 33222, 33233, 33234, 33235, 33240, or 33249. • Disconnection of leads, reconnection of leads, reprogramming of parameters, and testing of leads and pulse generator are included in these codes for pacemaker devices. For ICD or CRT-D devices, defibrillator threshold testing of lead(s) and/or pulse generator is separately billable by codes 93640–93642. • If the leads are connected to a cardioverter-defibrillator and the device and leads are tested following induction of arrhythmia at the time of the initial implantation, report separately with code 93641. • If only the leads are tested following induction of arrhythmia at the time of the initial implantation, report separately with code 93640. • Temporary pacing is not included and should be reported separately (33210 or 33211). • Extraction of a chronic lead is not included and should be reported separately (33244). • If a full and complete diagnostic subclavian venogram is performed (medical necessity established, images obtained and findings documented), report it separately with codes 36005 and 75820. Code 36005 may need modifier 59 attached. If subclavian venogram is performed to determine vein patency or for roadmapping purposes, code 75820 and 36005 should not be billed. • If fluoroscopic guidance is documented, report code 71090. Assign modifier 26 to describe the professional component of hospital-based services. Check with Physician Reimbursement Primer for Cardiac Rhythm Management 33
Page 1 and 2: GuidePoint GuidePoint is simplifyin
Page 3 and 4: Contents Chapter 1: Introduction ..
Page 5: How This Guide Is Organized Ablatio
Page 8 and 9: Chapter 1 Acronym Term CRM cardiac
Page 10 and 11: Chapter 2 detail below). This payme
Page 12 and 13: Chapter 2 procedure, the hemodynami
Page 14 and 15: Chapter 2 MS-DRG Logic for CRM Proc
Page 16 and 17: Chapter 2 10 Physician Reimbursemen
Page 18 and 19: Chapter 3 relatively rare, they can
Page 20 and 21: Chapter 3 3. Sino-atrial block or s
Page 22 and 23: Chapter 3 Since there are more than
Page 24 and 25: Chapter 3 c. Ejection fractions mus
Page 26 and 27: Chapter 3 At this time there is no
Page 28 and 29: Chapter 3 Cardiac Resynchronization
Page 30 and 31: Chapter 4 because the physician may
Page 32 and 33: Chapter 5 • Disconnection of lead
Page 34 and 35: Chapter 5 • Temporary pacing is n
Page 36 and 37: Chapter 5 Pacemaker Revision to Ski
Page 40 and 41: Chapter 5 individual payers regardi
Page 42 and 43: Chapter 5 Outpatient Procedure Codi
Page 44 and 45: Chapter 5 • Do not report this co
Page 46 and 47: Chapter 5 • Assign modifier 26 to
Page 48 and 49: Chapter 5 • Code 93652 is reporte
Page 52 and 53: Chapter 6 Case Study 3 Procedure De
Page 54 and 55: Chapter 6 resistance 577, threshold

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