Cracking the Code

Coding Pacemakers

Pacemakers send electrical pulses to help a heartbeat at a normal rate and rhythm. They also can be used to help the heart chambers beat in sync so the heart can pump blood more efficiently to your body. This may be needed if a patient has heart failure. Pacemakers can be short-term or long-term (permanent). A temporary pacemaker is normally inserted through a vein in the neck and remains outside your body. A permanent pacemaker is placed in your chest or abdomen.

To code these procedures, you will need to know the type of system, whether the placement is temporary or permanent, and whether the device is single, dual, multiple leads, or leadless. You will also need to know the placement of the electrodes, what procedure is being performed (removal, replacement, or insertion), and what component(s) are being removed, replaced, or inserted such as pulse generator or leads.

For pacemakers, there are different codes for a single or dual-chamber system. The chamber refers to the right atrium or right ventricle. A single chamber system has one electrode inserted in either the atrium or the ventricle. A dual chamber system has a lead inserted into the right atrium and another lead into the right ventricle. CPT codes 33206 and 33207 are for the placement of single-chamber pacemaker systems. CPT code 33208 is for a dual chamber pacemaker system placement. These codes are for the complete system (generator and electrodes). If only the generator is placed, we would want to consider CPT codes 33212, 33213, and 33221. Implantation of a leadless pacemaker (transcatheter approach) is reported with 33274 and 33275 is reported for removal.

Q: A 64-year-old male presents for removal and replacement of his permanent dual chamber transvenous pacemaker system (generator and leads). What CPT code(s) are reported for this service?
A: 33235, 33208-51, 33233-51. Rationale: Multiple codes are needed to show the entire procedure. 33235 is for removing the electrodes, 33208 is for putting in the new system, and 33233 is for removing the pacemaker pulse generator. These codes can be found in our CPT books under Cardiac Assist Devices/Pacemaker System in the Index. Modifier 51 is reported as it supports multiple procedures performed during the same session.
Reference: FY 2023 CPT codebook. Mayo Clinic
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