On Demand: EP Series Part 1: Device Procedures - Basic Pacemaker, Defibrillator and Subcutaneous Monitor Systems-Presentation Slides

Presentation Slides

Pdf Summary

This MedAxiom webinar reviews coding for basic electrophysiology device procedures involving permanent pacemakers, implantable cardioverter-defibrillators (ICDs), cardiac resynchronization therapy (CRT), subcutaneous ICDs, and subcutaneous cardiac monitors. It explains how to distinguish among new system implants, generator changes, generator changes with lead work, and generator attachment to existing leads.<br /><br />Key CPT code groups covered include:<br />- New pacemaker/ICD systems: 33206, 33207, 33208, 33249<br />- Straight generator changes: 33227–33229 and 33262–33264<br />- Lead removal: 33234–33244<br />- Generator removal: 33233, 33241<br />- Lead insertion/reposition/repair: 33202, 33215–33220, 33216–33218<br />- Pocket relocation: 33222, 33223<br />- LV lead insertion: 33224–33226, plus 33225 for coronary sinus LV lead placement<br />- DFT/NIPS testing: 93640–93644<br />- Subcutaneous ICD codes: 33270–33273<br />- Insert/remove subcutaneous rhythm monitor: 33285, 33286<br /><br />The presentation emphasizes common bundling rules: fluoroscopy, venography used only for access/road mapping, ultrasound guidance, and temporary pacemaker insertion are generally not separately billable when performed as part of these procedures. It also notes that His bundle and left bundle branch pacing should be coded according to current guidance, with 33225 not appropriate for left bundle branch pacing.<br /><br />A major section reviews Medicare National Coverage Determination rules for pacemaker and ICD implantation, including covered and non-covered indications and the use of modifiers KX, SC, GA, and GZ. Several case examples illustrate correct code selection for His bundle lead procedures, new pacemaker implantation, generator change with lead work, BiV ICD upgrade with LV lead placement, system upgrade, downgrade, and left bundle area pacing.<br /><br />Overall, the webinar is a practical coding guide for device implantation, replacement, lead work, and related documentation requirements.

Keywords

electrophysiology

pacemaker coding

ICD procedures

CRT devices

generator change

lead insertion

CPT codes

Medicare NCD

His bundle pacing

subcutaneous ICD