2012 – Physician Services Lab Sheet

2012 – Physician Services Lab Sheet
Cardiac Rhythm Disease Management
Patient Name
Date
Physician
IP
or OP
ICD Registry? YES
PACEMAKER SYSTEM IMPLANTS
DEVICE FOLLOW-UP PACEMAKERS IN PERSON
❏
33206
Insert new or replace perm PM w/atrial lead
❏
33207
Insert new or replace perm PM w/ventricular lead
❏
33208
Insert new or replace perm PM w/atrial and ventricular leads
PACEMAKER GENERATOR PROCEDURES
❏
33212
Insert PM generator only; w/existing single lead
❏
33213
Insert PM generator only; w/existing dual leads
❏
93279**
Programming device evaluation; single lead pacemaker
system
❏
93280**
Programming device evaluation; dual lead pacemaker
system
❏
93281**
Programming device evaluation; multiple lead pacemaker
system
❏
93288**
Interrogation device evaluation; single, dual, or multiple lead
pacemaker system
❏
33221
Insert PM generator only; w/existing multiple leads
❏
33227
Remove perm PM generator w/replacement of PM
generator; single lead system
❏
33228
Remove perm PM generator w/replacement of PM
generator; dual lead system
❏
93294
Interrogation device evaluation(s); single, dual, or multiple
lead pacemaker system – PC
❏
33229
Remove perm PM generator w/replacement of PM
generator; multiple lead system
❏
93296
Interrogation device evaluation(s); single, dual, or multiple
lead pacemaker/ICD system – TC
❏
33233
Remove perm PM generator only
REMOTE PACEMAKER (UP TO 90 DAYS; Do not report if the
monitoring period is less than 30 days)
OTHER PACEMAKER DEVICE EVALUATIONS OR ELECTRONIC ANALYSIS
PACEMAKER LEADS
❏
33210
Insert/replace temp lead/catheter – single chamber lead
❏
33211
Insert/replace temp lead/catheter – dual chamber leads
❏
33215
Reposition previously implanted transvenous right atrial or
right ventricular lead
❏
33216
Insert single transvenous lead, perm PM or ICD
❏
33217
Insert 2 transvenous leads, perm PM or ICD
❏
93293**
TTM rhythm strip pacemaker evaluation(s), up to 90 days
❏
93286**
Peri-procedural device evaluation (in person) and
programming device system parameters before or after a
surgery, procedure, or test; pacemaker system
❏
93724**
Electronic analysis of antitachycardia pacemaker system
COMPREHENSIVE EP EVALUATIONS
❏
93619**
Comp EP eval; RA and RV pacing/recording/His
❏
93620**
Comp EP eval w/arrhythmia; RA and RV pacing/recording/His
❏
+93621**
Comp EP eval w/arrhythmia; LA pacing/recording from CS
or LA
❏
33218
Repair single transvenous lead, perm PM or ICD
❏
33220
Repair 2 transvenous leads, perm PM or ICD
❏
33224
Insert LV lead, attach to previously placed generator
❏
+93622**
Comp EP eval w/arrhythmia; LV pacing/recording
❏
+33225
Insert LV lead at time of generator implant
❏
+93623**
Programmed stimulation and pacing after IV drug infusion
❏
33226
Reposition previously implanted LV lead
RECORDING, MAPPING, AND PROCEDURES
❏
33234
Remove transvenous pacemaker single lead system
❏
93600**
Bundle of His recording
❏
33235
Remove transvenous pacemaker dual lead system
❏
93602**
Intra-atrial recording
❏
93603**
Right ventricular recording
Upgrade single PM to dual PM (includes removal of PM
generator, test existing lead, insert new lead and insert new
PM generator)
❏
+93609**
Intraventricular and/or intra-atrial mapping of tachycardia
❏
93610**
Intra-atrial pacing
Revision/relocation of skin pocket for pacemaker
❏
93612**
Intraventricular pacing
❏
+93613
Intracardiac electrophysiologic 3-D mapping
Insert new or replace perm PM w/atrial lead
❏
93615**
Esophageal recording of atrial electrogram
Insert new or replace perm PM w/ventricular lead
❏
93616**
Esophageal recording of atrial electrogram; w/pacing
Insert new or replace perm PM w/atrial and ventricular leads
❏
93618**
Induction of arrhythmia by electrical pacing
33212
Insert PM generator only; w/existing single lead
❏
93624**
EP follow-up w/pacing/recording w/induction or attempted
induction of arrhythmia
❏
93631**
Intra-operative epicardial/endocardial pacing/mapping
❏
93660**
Tilt table evaluation
PACEMAKER OTHER
❏
❏
33214
33222
CRT-P IMPLANT*
❏
❏
❏
❏
33206
33207
33208
❏
33213
Insert PM generator only; w/existing dual leads
❏
33214
Upgrade single PM to dual PM (includes removal of PM
generator, test existing lead, insert new lead and insert new
PM generator)
❏
33221
Insert PM generator only; w/existing multiple leads
❏
+33225
Insert LV lead at time of generator implant
OTHER COMMENTS
❏
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2012 – Physician Services Lab Sheet
ICD (IMPLANTABLE CARDIOVERTER-DEFIBRILLATOR) SYSTEM IMPLANT
33249
Insert or replace perm pacing ICD system with transvenous
lead(s), single or dual chamber
❏
93641**
Test device/leads at initial implant or replacement
ICD GENERATOR PROCEDURES
❏
33230
Insert ICD generator only; w/existing dual leads
❏
33231
Insert ICD generator only; w/existing multiple leads
❏
33240
Insert ICD generator only; w/existing single lead
❏
33241
Remove ICD generator only
❏
33262
Remove ICD generator w/replacement of ICD generator;
single lead system
❏
33263
Remove ICD generator w/replacement of ICD generator;
dual lead system
❏
33264
Remove ICD generator w/replacement of ICD generator;
multiple lead system
33215
Reposition previously implanted transvenous right atrial or
right ventricular lead
❏
93298
Interrogation device evaluation(s); ILR – PC
❏
93299
Interrogation device evaluation(s); ICM or ILR – TC
Device Follow-Up: ICM (Implantable Cardiovascular
Monitor) In Person
❏
93290**
Interrogation device evaluation; ICM
REMOTE ICM (Up to 30 days; Do not report if the monitoring
period is less than 10 days)
❏
93297
Interrogation device evaluation(s); ICM – PC
❏
93299
Interrogation device evaluation(s); ICM or ILR – TC
CATHETER ABLATIONS
ICD LEADS
❏
REMOTE ILR (Up to 30 days; Do not report if the monitoring
period is less than 10 days)
❏
93650
Catheter ablation AV node w or w/o temp pacemaker
❏
93651
Catheter ablation for SVT
❏
93652
Catheter ablation for VT
❏
+93462
Left heart cath by transseptal puncture
❏
+93662**
Intracardiac echo during intervention/includes imaging
CARDIOVERSION
❏
33216
Insert single transvenous lead, perm PM or ICD
❏
33217
Insert 2 transvenous leads, perm PM or ICD
❏
92960
Cardioversion, elective, conversion of arrhythmia; external
❏
33218
Repair single transvenous lead, perm PM or ICD
❏
92961
Cardioversion, elective, conversion of arrhythmia; internal
❏
33220
Repair 2 transvenous leads, perm PM or ICD
❏
33224
Insert LV lead, attach to previously placed generator
❏
+33225
Insert LV lead at time of generator implant
❏
33226
Reposition previously implanted LV lead
❏
93303**
Echo transthoracic, congenital; complete
Remove single or dual ICD leads; by thoracotomy
❏
93304**
Echo transthoracic, congenital; follow-up/limited study
Remove single or dual ICD lead(s); by transvenous extraction
❏
93306**
Echo transthoracic 2-D, complete w/spectral and color flow
Doppler
❏
93307**
Echo transthoracic 2-D, complete w/o spectral and color flow
Doppler
CRT-D IMPLANT*
❏
93308**
Echo transthoracic 2-D, follow-up/limited study
❏
+33225
Insert LV lead at time of generator implant
❏
+93320**
Doppler pulsed/continuous wave; complete
❏
33230
Insert ICD pulse generator only; with existing dual leads
❏
+93321**
Doppler pulsed/continuous wave; follow-up/limited study
❏
33231
Insert ICD pulse generator only; with existing multiple leads
❏
+93325**
Doppler echo color flow velocity mapping
❏
33240
Insert ICD pulse generator only; with existing single lead
❏
33249
Insert or replace perm pacing ICD system with transvenous
lead(s), single or dual chamber
❏
❏
33243
33244
EP ICD DEVICE FOLLOW-UP
❏
ICD OTHER
❏
❏
33223
93641**
Revision of skin pocket for ICD
DEVICE FOLLOW-UP: ICDs IN PERSON
❏
93282**
Programming device evaluation; single lead ICD system
❏
93283**
Programming device evaluation; dual lead ICD system
❏
93284**
Programming device evaluation; multiple lead ICD system
❏
93289**
Interrogation device evaluation; single, dual, or multiple lead
ICD system
❏
93295
Interrogation device evaluation(s); single, dual, or multiple
lead ICD system – PC
❏
93296
Interrogation device evaluation(s); single, dual, or multiple
lead pacemaker/ICD system – TC
OTHER ICD DEVICE EVALUATIONS
❏
93287**
Peri-procedural device evaluation (in person) and
programming device system parameters before or after a
surgery, procedure, or test; ICD system
ILR (IMPLANTABLE LOOP RECORDER)
❏
33282
Implant patient-activated cardiac event recorder
❏
33284
Remove implantable patient-activated cardiac event
recorder
DEVICE FOLLOW-UP: ILR IN PERSON
❏
93285**
Programming device evaluation; ILR
❏
93291**
Interrogation device evaluation; ILR
EP evaluation single/dual ICD
WEARABLE ICD VEST IN PERSON
Test device/leads at initial implant or replacement
REMOTE ICD (UP TO 90 DAYS; Do not report if the monitoring
period is less than 30 days)
93642**
TRANSTHORACIC ECHOCARDIOGRAPHY
❏
93292**
Interrogation device evaluation; wearable defibrillator system
❏
93745**
Initial set-up and programming, wearable ICD
Commonly Used Modifiers:
Q0 (zero): Denotes primary prevention patient for Medicare ICD device implants
-22: Increased procedural services (work required to provide a service is substantially greater)*
-25: Significant, separately identifiable E & M service by the same physician on the same day of
the procedure or other service*
-26: Professional component*
-51: Multiple procedures rendered at the same operative session by the same provider (payer
dependent)*
-52: Reduced services*
-53: Discontinued procedure (physician elects to terminate a surgical or diagnostic procedure)*
-76: Repeat procedure or service by same physician or other qualified health care professional*
-78: Unplanned return to the OR/procedure room by the same physician or other qualified
health care professional following initial procedure for a related procedure during the
postoperative period*
-79: Unrelated procedure or service by the same physician during the postoperative period*
NOTES:
Codes indicated with a + symbol in front of them are “add-on” codes; bill in addition to the
primary service/procedure.
TC: Technical Component; PC: Professional Component
* CPT® copyright 2011 American Medical Association. All rights reserved. CPT is a registered
trademark of the American Medical Association.
** Service performed in a facility setting (i.e., hospital) may require a -26 modifier that
represents professional component only.
These coding suggestions do not replace seeking coding advice from the payer and/or your
own coding staff. The ultimate responsibility for correct coding lies with the provider of
services. Please contact your local payer for interpretation of the appropriate codes to use
for specific procedures. Medtronic makes no guarantee that the use of this information will
prevent differences of opinion or disputes with Medicare or other third party payers as to the
correct form of billing or the amount that will be paid to providers of service.
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UC200804760d EN © Medtronic, Inc. 2011. Minneapolis, MN. All Rights Reserved. Printed in USA. 12/2011
❏