To code removal of leads from a pacemaker or an ICD device, you first need to determine which device the patient has and then look for the approach to removing the leads. 33234: Removal of transvenous pacemaker electrode (s); single lead system, atrial or ventricular
2021 ICD-10-PCS Procedure Code 02HK3JZ Insertion of Pacemaker Lead into Right Ventricle, Percutaneous Approach 2016 2017 2018 2019 2020 2021 Billable/Specific Code ICD-10-PCS 02HK3JZ is a specific/billable code that can be used to indicate a procedure.
02PA3MZ is a valid billable ICD-10 procedure code for Removal of Cardiac Lead from Heart, Percutaneous Approach . It is found in the 2021 version of the ICD-10 Procedure Coding System (PCS) and can be used in all HIPAA-covered transactions from Oct 01, 2020 - Sep 30, 2021 .
Insertion: In cardiovascular procedures, the insertion root operation is used for pacemakers, defibrillators, and cardiac resynchronization devices. Similar to ICD-9-CM, pacemaker insertion in ICD-10-PCS requires a code for placement of the generator as well as insertion of the lead (s).
02HK3JZ02HK3JZ, Insertion of pacemaker lead into right ventricle, percutaneous approach.
Pacemakers are used to manage slow heart rhythms and ICDs to treat dangerously fast heart rhythms. Each device has two main components: a pulse generator and one or more wires known as leads. A lead revision involves repositioning a lead within the heart muscle, or replacing it with a new one.
Z95.0ICD-10-CM code Z95. 0 is used to report the presence of a cardiac pacemaker without current complications. If the device is interrogated, code Z45. 018 would be reported as it is no longer just the presence of the device but attention to the device.
V53. 31 for pacer, V53. 32 for ICD.
These leads can deliver a burst of energy in both pacemakers and ICDs. This burst of energy can cause the heart to beat more quickly (in a pacemaker), or it can stop dangerous rapid heart rhythms (in an ICD).
Occasionally, pacemaker and implantable cardioverter defibrillator systems must be removed. The removal of such systems is potentially a high-risk procedure. With the increasing number of implanted devices, removal is required more frequently.
ICD-9 Code Transition: 786.5 Code R07. 9 is the diagnosis code used for Chest Pain, Unspecified. Chest pain may be a symptom of a number of serious disorders and is, in general, considered a medical emergency.
Hyperlipidemia, UnspecifiedCode E78. 5 is the diagnosis code used for Hyperlipidemia, Unspecified, a disorder of lipoprotein metabolism other lipidemias. It is a condition with excess lipids in the blood.
Z95.810Z95. 810 - Presence of automatic (implantable) cardiac defibrillator is a topic covered in the ICD-10-CM.
Group 1CodeDescription33249INSERTION OR REPLACEMENT OF PERMANENT IMPLANTABLE DEFIBRILLATOR SYSTEM, WITH TRANSVENOUS LEAD(S), SINGLE OR DUAL CHAMBER33262REMOVAL OF IMPLANTABLE DEFIBRILLATOR PULSE GENERATOR WITH REPLACEMENT OF IMPLANTABLE DEFIBRILLATOR PULSE GENERATOR; SINGLE LEAD SYSTEM23 more rows
When pacemakers near the end of life, an Elective Replacement Indication (ERI) period triggers automatic setting changes (ventricular only pacing and/or rate response (RR) loss) in most devices.
Pacemaker or Implantable Defibrillator ProceduresCPT® 33241, Under Pacemaker or Implantable Defibrillator Procedures. The Current Procedural Terminology (CPT®) code 33241 as maintained by American Medical Association, is a medical procedural code under the range - Pacemaker or Implantable Defibrillator Procedures.
The procedure usually takes between 1 and 2 hours, but it can take longer if you're having other heart surgery at the same time.
The entire process of extraction may take two to six hours, depending on how many leads you have and how long they've been implanted, or how much tissue has built up around them. In most cases, the pacemaker or ICD leads (or the entire device) are replaced in the same surgery.
Baseline patient characteristics are summarized in Table 1: The median patient survival after pacemaker implantation was 101.9 months (approx. 8.5 years), at 5, 10, 15 and 20 years after implantation 65.6%, 44.8%, 30.8% and 21.4%, respectively, of patients were still alive.
They work for 5 to 10 years before they need to be replaced. To replace the pulse generator, you will need an implantable device replacement procedure. The leads are wires that run between the pulse generator and your heart. These leads can give a burst of energy.
02PA3MZ is a valid billable ICD-10 procedure code for Removal of Cardiac Lead from Heart, Percutaneous Approach . It is found in the 2021 version of the ICD-10 Procedure Coding System (PCS) and can be used in all HIPAA-covered transactions from Oct 01, 2020 - Sep 30, 2021 .
Removal involves: Taking out or off a device from a body part. If a device is taken out and a similar device put in without cutting or puncturing the skin or mucous membrane, the procedure is coded to the root operation CHANGE. Otherwise, the procedure for taking out a device is coded to the root operation REMOVAL.
Categories Z00-Z99 are provided for occasions when circumstances other than a disease, injury or external cause classifiable to categories A00 -Y89 are recorded as 'diagnoses' or 'problems'. This can arise in two main ways:
The 2022 edition of ICD-10-CM Z45.018 became effective on October 1, 2021.
A removal procedure is coded for taking out a device that was used in a previous replacement procedure; in other words, a complete re-do. If the previously placed device is completely removed and replaced, both removal and replacement procedure codes would be assigned.
In a replacement procedure, the objective is to replace the body part or a portion of the body part. This seems pretty straightforward. A caveat to remember is that if the code for replacement is assigned, the replacement code also captures the removal of the body part being replaced, and as such the removal or excision of the body part is not coded separately. A joint replacement, a bone graft, and a free skin graft are examples of replacement procedures.
Replacement: putting in or on biological or synthetic material that physically takes the place and/or function of all or a portion of a body part. Removal: taking out or off a device from a body part. Revision: Correcting to the extent possible a portion of a malfunctioning device or the position of a displaced device.
Based on theory, it would seem that ICD-10-PCS root operations could be assigned correctly with relative ease; however, practical application sometimes intersects with coding scenarios that make one question the selection of the appropriate root operation.
It is important to note that the pacemaker generator is placed in the subcutaneous tissue of the chest. The correct body system is subcutaneous tissue and fascia. A common error occurs when using the Alphabetic Index, under Insertion, Chest Wall. This index entry directs the coder to table OWH8, which may appear to be correct until character 6, device. On this table, there is no device character to identify the dual chamber pacemaker. When using the tables in ICD-10-PCS, if a code seems “almost right,” review the table to ensure the row of the table—or even the table itself—is correct.
ICD-10-PCS Guideline B3.9. If an autograft is obtained from a different body part in order to complete the objective of the procedure, a separate procedure is coded.
Two codes are necessary to fully explain the CABG x4 with three vessels being bypassed with the LIMA and one vessel treated using the saphenous vein graft. The excision of the saphenous vein is coded separately and the documentation needs to indicate both laterality and greater or lesser saphenous vein. This is a documentation opportunity, which can be addressed with the provider.
Supplement: This root operation can often be difficult to apply, but with cardiovascular procedures, surgeries such as mitral valve annuloplasty would be coded to supplement.
While these root operations are not the only ones applicable to cardiovascular procedures, they are some of the most common.
Code CPT 33235 for removal of transvenous pacemaker electrodes through these methods when the patient has a dual lead (chamber) system (leads in both the right ventricle and the right atrium) whether leads are removed from the right atrium, the right ventricle, or both. The final code is not based on how many chambers from which leads are removed, but on how many chambers in which leads exist at the start of the case.
Instead there are two codes in total — 33243 for an open chest incision approach which can include removal of leads by thoracotomy or sternotomy and 33244 for transvenous removal which would involve the same methods described for transvenous pacemaker lead removal (pulling, twisting, or placing traction to remove the lead). These codes are reported regardless of how many leads are removed and regardless of how many chambers in which leads exist.
The terms single and dual lead system have the same definitions as they do for transvenous pacemaker leads – use 33237 if removing lead (s) from a pacemaker with electrodes overlying the right atrium and right ventricle whether leads are removed from the surface of the right atrium, the right ventricle, or both.
Single Chamber: A pacemaker or ICD with leads in only one chamber of the heart (i.e., right atrium or right ventricle). Dual Chamber: A pacemaker or ICD with leads in two chambers of the heart (i.e., right atrium and right ventricle)
Modifier 22 is for significant increased complexity and is designed to increase the billed and reimbursed amounts for a given code to reflect that the work involved in a particular procedure was significantly more complex than typical. The modifier in the context of a laser lead removal explains the increased work of removing transvenous lead (s) with a laser sheath. There is an increase in the time it takes to remove the leads as well as in the complexity of the procedure/risk to the patient when this much scar tissue is present. Crediting the modifier is the best way to give the physician credit for this increased work.
Transvenous: This word means “through or across a vein.” In the context of codes for pacer and ICD lead removal, if the code description states removal of “transvenous” electrodes/leads, the code is used to report removal of leads that were previously placed by accessing a vein such as the internal jugular or subclavian vein and then placing the leads through that vein and into the heart. In this way, you work “through the vein” to gain access to the heart with the leads.
Multi-Chamber or Biventricular: In the context of pacemakers and ICDs, either term refers to a device with leads in the right atrium, right ventricle, and left ventricle. Sometimes these devices have leads in the right ventricle and left ventricle only without a right atrial lead – that device is still considered “biventricular” since leads are in both ventricles.
There is no code that specifically describes removal of a left ventricular (LV) lead, nor a specific code for the removal of more than two leads (multi lead system). Therefore, if the cardiovascular device system is not single or dual-lead, it may be appropriate to report code 33999, Unlisted procedure, cardiac surgery.
Moderate sedation is now separately billed using the new moderate sedation codes. Six new CPT codes CPT 99151-99157 were created. Providers should report the appropriate moderate sedation code(s) in addition to the procedure CPT codes when moderate sedation is performed. For further coding instructions, please refer to the coding guidelines and moderate sedation table in 2018 CPT Professional.
Modifier -53 should be appended to the procedure that was not completed. Documentation will be required for consideration of payment.
In the outpatient setting, when devices are used in combination with device-related procedures, hospitals report C codes. While the supply codes are not paid separately from the procedure, the assignment of charges and reporting these supply codes, identify device-related costs. This information is important for future rate-setting by Medicare. Private payers’ policies vary if they accept the use of these C codes.
If the surgeon has a more complicated case than usual and/or spends an unusually long time extracting the leads, they may be able to receive additional payment if the documentation and procedure time supports the additional work.