Cracking the Code

Coding Permanent Dual-chamber Pacemakers

Sick sinus syndrome (SSS) is a disorder of the heart’s natural pacemaker. Typically, SSS is treated with an implanted pacemaker. A pacemaker consists of a small, battery-powered generator and one or more leads. With a single-chamber system, only one lead is used. With a double-chamber system, two leads are used and placed in the right atrium and right ventricle.

ICD-10-PCS Codes: 0JH606Z, Insertion of pacemaker generation, 02H63JZ, insertion of device in atrium, and 02HK3JZ, insertion of device in ventricle

CPT Codes: 33208, insertion of new or replacement of permanent pacemaker with transvenous electrode(s); atrial and ventricular

Q: A patient presents to the ED with complaints of sick sinus syndrome. The physician admits the patient and determines that surgery intervention is necessary. A permanent dual chamber pacemaker with atrial and ventricular leads was implanted. An incision was made into the left chest wall with the dual chamber pacemaker being placed in the subcutaneous pocket. Next, a small incision was made into the skin and the leads were percutaneously passed into the right ventricle and right atrium
A: I49.5, sick sinus syndrome
Reference: ICD-10-PCS Coding Guideline B4.4
CPT Assistant, June 2012 pages 3-9: Pacemaker and pacing cardioverter-defibrillator reporting
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