Health Information Management

Ask the expert: How do I correctly report codes 33202 and 33213?

HIM-HIPAA Insider, July 30, 2007

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Q: A patient presents to the cardiologist for an initial insertion of a dual chamber pacemaker system with epicardial electrodes placed via thoracotomy. The physician places the electrodes and pulse generator during the same surgical session. How should we report this using the new codes for 2007, and what will the APC payment rate be?

A: Using the new 2007 codes for pacemaker insertion, you would report the above scenario using the following codes:

  • 33202-Insertion of epicardial electrode(s), open incision (e.g., thoracotomy, median sternotomy, subxiphoid approach)
  • 33213-Insertion or replacement of pacemaker pulse generator only, dual chamber

The instructional note under the new codes 33202 and 33203 prompts you to use these codes in conjunction with 33212, 33213 as appropriate. You will find the corresponding note under codes 33212, 33213, which refers you back to 33202, 33203 in the CPT Manual.

If the cardiologist performs an insertion via thoracotomy, then the patient must be admitted as an inpatient. CPT code 33202 has a status code that requires that the patient be treated as an inpatient per the APC final rule from April 7, 2000. If the hospital treats the patient as an outpatient, Medicare will deny the entire claim, and the hospital will not be allowed to appeal or resubmit the claim, resulting in a total loss of payment for the services provided. Additionally, Medicare cannot hold the patient liable in the case of denial of these charges.

Editor's note: This question and answer appeared in the August 2007 issue of APC Answer Letter. For more information, click here.

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