Lead Repair: Master Electrode Repair Coding Conundrum

Learn how to code lead repair as well as battery change at same session.

Medical coding for electrode repair is slightly clearer in 2012.

In 2011, your electrode (lead) repair choices for a pacemaker (PM) or implantable cardioverter-defibrillator (ICD) involved these two CPT codes:

33218 (Repair of single transvenous electrode for a single chamber permanent pacemaker or single chamber pacing cardioverter-defibrillator)

33220 (Repair of 2 transvenous electrodes for a dual chamber permanent pacemaker or dual chamber pacing cardioverter-defibrillator)

Problem: As per the wording in the 2011 definitions, neither code appeared suitable for repair of a single lead in a dual-chamber system. Code 33218 denoted a single lead in a single-chamber system, as well as 33220 denoted repairing two leads in a dual-chamber system. At one point, AMA's Principles of CPT® Coding (fourth edition) suggested reporting 33220-52 (Reduced services) to signify repair of a single electrode in a dual-chamber device.

2012 solution: CPT 2012 revises the code definitions to refer only to the number of electrodes and not the number of chambers involved:

33218 (Repair of single transvenous electrode, permanent pacemaker or pacing cardioverter-defibrillator)

33220 (Repair of 2 transvenous electrodes, permanent pacemaker or pacing cardioverter-defibrillator)

Based on the above definitions, the suitable code for single-electrode repair when the date of service is on or after Jan. 1, 2012, appears to be 33218.

Battery Change + Lead Repair = Multiple Codes

Owing to changes elsewhere in the PM and ICD range of CPT®, the codes you'll pair with 33218 and 33220 for lead repair at the same session as a battery change have a new look.

A note with 33218 tells that when the physician repairs a single electrode for a PM or ICD at the similar session as pulse generator replacement, you must report 33218 with the correct code from:

33227-33229 (Removal of permanent pacemaker pulse generator with replacement of pacemaker pulse generator…)

33262-33264 (Removal of pacing cardioverter-defibrillator pulse generator with replacement of pacing cardioverter-defibrillator …)

Code 33220 has its own individual new note asking you to report repair of two transvenous electrodes and generator replacement at the similar session using 33220 in conjunction with the single suitable code from:

33228 (dual lead PM battery change)

33229 (multiple lead PM battery change)

33263 (dual lead ICD battery change)

33264 (multiple lead ICD battery change).

Problem: CCI edits 2012 shows edits bundling dual- and multiple-lead PM battery changes (33228-33229) with single lead repair CPT 33218. The edits have a modifier indicator of 0, so you may not override the edits. The edits as mentioned in CCI edits 2012 could cause reporting problems if the physician repairs a single lead at the same session as a battery change for a dual- or multiple-lead system.

For further details on this and for other medical coding updates, sign up  http://www.supercoder.com/.