CPT Codes +33225 Pacing Systems: Confusion? Here is the Solution

Mark this LV-lead modification in your manual.

Some biventricular upgrade cases have been frustrating for medical coders, but there’s good news.

Looking for the accurate code combination is much easier now that the AMA has published an official rectification to the main CPT codes you might report with +33225 (Insertion of pacing electrode, cardiac venous system, for left ventricular pacing, at time of insertion of pacing cardioverter-defibrillator or pacemaker pulse generator [including upgrade to dual chamber system and pocket revision] [List separately in addition to code for primary procedure]).

Add Gen Change Codes to Primary Options

The corrections document for AMA’s CPT® 2012 manual reviews the parenthetical instruction following +33225. The revision adds four CPT codes to the list of possible primary codes for +33225:

• 33228 (Removal of permanent pacemaker pulse generator with replacement of pacemaker pulse generator; dual lead system
• 33229, … multiple lead system)
• 33263 (Removal of pacing cardioverter-defibrillator pulse generator with replacement of pacing cardioverter-defibrillator pulse generator; dual lead system)
• 33264 (… multiple lead system)

Keep in mind that because +33225 is an add-on code, you should report it in addition to a primary code. You may never report +33225 without an accurate primary code.

Review These Upgrade Cases for Denials

The addition of CPT codes 33228, 33229, 33262, and 33264 to the list of primary codes resolves an issue many coders have faced as the codes became effective in January.

Affected cases are upgrades from a single- or dual-lead pacemaker or implantable cardioverter-defibrillator system to a biventricular (BiV) system. Specifically, the cases involve the physician placing the left ventricle lead (+33225), altering the pulse generator, and connecting earlier placed lead(s) to the new battery.

For instance, assume the physician does away with an existing single pacer generator, inserts a BiV pacer generator, connects the present right ventricle (RV) lead, and implants and connects a new left ventricle (LV) lead. The 2012 coding guidelines originally published didn’t propose clear guidance on how to code this scenario.

The problem: The logical assumption is that you must report +33225 with the applicable generator change code when a case includes LV lead placement (+33225) and generator change (such as 33228, 33229, 33263, or 33264). However, CPT® did not list the novel generator change codes as acceptable primary codes for +33225.

Result: When practices attempted to report the generator change CPT codes along with +33225, they received denials.

Practices were left trying to find a different coding option. Some coders wondered if at all they could code the LV lead placement (+33225), a new system insertion (such as 33206-33208, Insertion of new or replacement of permanent pacemaker with transvenous electrode[s] …), and possibly battery removal (such as 33233, Removal of permanent pacemaker pulse generator only). This is technically inappropriate from a coding perspective as there was an LV lead added, however no RA or RV lead changed. The new system codes need lead insertion or replacement, so CPT codes 33206-33208 would not be appropriate here.