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Click here for more sample CPC practice exam questions and answers with full rationale

Scheduled Follow Up with Pacemaker interrogation

Patient seen every 4 months. Chief complaint exactly the same every time ; dual chamber pacemaker implant due to complete av block, 2003, Hypertension, Hyperlipidemia and Hypothyroidism.
HPI: also the same copied and pasted from original history of pacemaker implant and continues as HPI with minor tweaks; Patient presented with chest pain and nausea, september 2003, diagnosed with AV block, dual chamber implanted, asymptomatic since implant. No current complaints except toe pain. Pacemaker interrogated today and shows: _____ blah blah blah___
ROS: negative except for HPI
Exam: We’ll say comprehensive for the sake of brevity. + toe pain
Impression:
Pacemaker function normal
Complete AV Block, asymptomatic
Hypertension
Hyperlipidemia
Hypothyroidism

Can a patient’s history of pacemaker implant and historical and/or maintenance conditions that are stable or asymptomatic, be carried over every visit to qualify as an E/M? Wouldn’t there have to be a chief complaint? These seem like periodic scheduled pacemaker interrogations that are being upcoded with an E/M visit. Billed as 99214 with 93280, every 4 -6 months. This provider is somewhat hostile. How do I tell him without accusing him that this E/M is not warranted, or is it? I try explaining medical necessity, I try explaining components of E/M, I’m written lengthy essays on how complicated this case was etc.., Makes me very uncomfortable to submit these claims. Had one today whereby patient was experiencing a noisy lead on PM, no other complaints, saw the patient 2 weeks prior for the same reason, both visits billed as 99215 with 93280.

Medical Billing and Coding Forum

pacemaker lead extraction and explantation of generator

Can anyone tell me if you can bill 33233 for removal of generator along with 33235? The generator and leads are removed without reinsertion. The guidelines state "When reporting the system insertion or replacement codes, removal of a pulse generator (33233 or 33241) may be reported separately, when performed". Am I correct that removal of transvenous electrode(s) (33234,33235 or 33244) includes explantation of the generator if it is not being replaced or upgraded?

Thank you

Medical Billing and Coding Forum

Coding for Pacemaker Pocket Revision

My provider did a revision for a permanent pacemaker pocket. The patient’s pacemaker moved into an uncomfortable position, so they had to relocate it to a different site. Everything I am reading tells me that this is included in other codes, but I am not sure what to use since that is all that was performed.

Can anyone help me properly this?

Thank you

Medical Billing and Coding Forum

Aborted pacemaker placement

Hi, I could use some advice on this please. Would you bill this as a pacemaker placement 33207 with a 53 modifier along with a Venography? I appreciate the info.

PROCEDURE: Venogram was done on the right and left side-patent venous system was confirmed. The patient was prepped and draped in the usual sterile fashion. Access was gained into the left axillary vein after venography and fluoroscopy-first with a micropuncture wire and then with a regular wire. Right sided placement was confirmed after passing the wire below the diaphragm. The prior incision (made at the outside hospital was opened). The two wires were brought out of the incision.
**
The ventricular lead was advanced directly via a 7 Fr long sheath and positioned in the right ventricular mid septum under fluoroscopy. Lead characteristics were measured and were satisfactory. After I split the sheath there was copious bleeding seen. These occurred to have an arterial pulsation and were seen around the lead as well as in an area more lateral and inferior to the lead. I placed several purse-string sutures around the lead and cauterized other areas that appeared to be bleeding. Hemostasis could not be achieved.
*
I finally called the cardiac surgeons, who also placed purse string sutures around the lead with no effect.
*
After a long discussion about possible causes, that included damage to an arterial branch around the vein, or the main axillary artery itself, I decided to pull out the lead. Hemostasis was finally obtained by manual compression with gauze. Using a staged approach, compression was gradually released and hemostasis was confirmed. The wound was closed by the surgeon-please see his note for details.

Medical Billing and Coding Forum

Abandoned ICD lead with Dual chamber pacemaker and leads removal

Can someone advise if we are able to code for the abandoned ICD lead removal separately or if would be included with the PM lead extraction code.(33235) I appreciate the assistance.

Dual chamber PM in situ with abandoned ICD lead codes requested.Thank you.

I don’t have my code book with me. I understand we would code for the PM generator removal & the 33235 for the leads but am not certain if we would use the ICD lead(s) removal code in this case.
Appreciate the assistance!

JB. CPC :confused:

Medical Billing and Coding | AAPC Forum