Cardiology

For the Week of May 23, 2016

I have a patient who received an implantable cardioverter-defibrillator (ICD) dual-chamber device from company A. During the defibrillation threshold testing (DFT) phase, the device would not convert the patient from ventricular fibrillation, and rescue shocks were performed. The patient returned the following day and a new ICD generator from company B was inserted. This device has a higher joule output that will allow the patient to be converted from the arrhythmia.

Can I assign the following CPT code for an ICD generator change?
33263  Removal of implantable defibrillator pulse generator with replacement of implantable defibrillator pulse generator; dual lead system

Code 33263 would be the correct code when the existing dual-chamber ICD generator was removed on a separate day from the initial insertion date and inserted and attached to the existing right atrium (RA) and right ventricle (RV) leads. For professional fee billing, assign the following modifier since this is within the global period (90 days).  

Modifier -78  Unplanned return to the operating/procedure room by the same physician or other qualified health care professional following initial procedure for a related procedure during the postoperative period

For hospital billing, the modifier -78 would not be needed as this is construed as a separate date of service and the global period does not apply.