Health Information Management

Tip of the Week: Overturn CCI edits with 33223, 33222: Use of modifier -59 warranted when physician documents "pocket revision"

APCs Insider, April 6, 2007

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When it comes to coding pacemaker/cardioverter-defibrillator insertions, many HIM professionals and coders mistakenly believe that you cannot report the following skin pocket revision codes:

  • 33223: Revision of skin pocket for single or dual chamber pacing cardioverter-defibrillator
  • 33222: Revision or relocation of skin pocket for pacemaker

with the following cardiac device insertion codes:

  • 33240: Insertion of single or dual chamber pacing cardioverter-defibrillator pulse generator
  • 33249: Insertion or repositioning of electrode lead(s) for single or dual chamber pacing cardioverter-defibrillator and insertion of pulse generator

They don't think they can report both codes because doing so causes them to bump up against a National Correct Coding Initiative (NCCI) edit, says Lolita Jones, RHIA, CCS, principal of Lolita M. Jones Consulting in Fort Washington, MD.

But don't be scared away by the edit. The official rules state that you can report both by appending modifier -59 (distinct procedural service) to the second code in the pair. Although reporting both codes triggers a CCI edit, you can overturn the edit if the documentation truly supports the fact that the physician performed a pocket revision, Jones says.

For example, if a physician has to alter a pre-existing pocket when inserting a dual-chamber pacing cardioverter-defibrillator pulse generator, report 33240 and 33223-59. This may be necessary when a patient has an infection that requires the physician to revise the pocket, or when the new device he or she is going to insert is too large for the existing pocket.

The critical guideline when reporting 33240 with 33223 is that the pocket has to be pre-existing, says Melissa Thurmond, CCS, at Mary Washington Hospital in Fredricksburg, VA. "If it (pocket) has not been made, and this is the initial insertion, then you cannot pick it up (33223)," she says.

(Source: Briefings on APCs, January 2007).

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