Health Information Management

Bill separately when replacing leads

APCs Insider, July 15, 2005

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Bill separately when replacing leads

QUESTION: A physician placed a pacer and leads in a patient, but the patient had to come back to our hospital the next day to have the leads removed due to poor lead response. The physician then inserted a different type of lead. Is the new lead bundled into the original procedure or can we bill it separately?

ANSWER: Under the OPPS, the insertion of the new lead is not bundled into the original procedure. The reason for the removal is inadequate response time or "poor response." When the patient returns the next day, code for the lead removal and the insertion, as they are two different CPT codes.

Furthermore, bill each encounter or visit separately. Do not combine separate encounters on separate dates of service for reporting/coding under the OPPS.

Code the procedure using CPT 33234 (removal of transvenous pacemaker electrode[s]; single lead system, atrial or ventricular), or 33235 (removal of transvenous pacemaker electrode[s]; dual lead system, atrial or ventricular), and CPT code 33216 (insertion of a transvenous electrode; single chamber) or 33217 (insertion of a transvenous electrode; dual chamber). It is important that the operative note states how many leads as well as the type of pacemaker chamber, either single or dual. CPT coding is dependent on these two factors. Refer to the January 2003 CPT Assistant, p. 23, for a good reference regarding this type of service.

In addition, facilities must report the appropriate device C code with the procedure. Effective January 1, 2005, hospitals paid under the OPPS (bill types 12X and 13X) that report procedure codes that require the use of devices must also report the applicable HCPCS codes and charges for all devices that are used to perform the procedures.

You can find a list of required codes at the CMS Web site: Click on the link for "revised list of device codes required for procedure codes in selected device dependent APCs."

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