Pacemaker vs. Defibrillator
Published On - August 13, 2025
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.
Pacemakers are medical devices used to regulate the
heart’s rhythm in patients with arrhythmias or other cardiac conditions. Proper
coding and billing for pacemaker procedures are critical in ensuring accurate
reimbursement for healthcare providers and maintaining compliance with
regulatory guidelines. This article outlines the essential aspects of medical
coding and billing for pacemakers, including key codes, billing practices, and
common challenges.
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.
Key Medical
Codes for Pacemaker Procedures
Medical coding for pacemakers involves using
standardized codes to represent the procedures, services, and devices involved.
The two main coding systems used for pacemaker-related procedures are ICD-10-CM (International Classification of Diseases, 10th Edition,
Clinical Modification) for diagnosis coding and CPT (Current Procedural Terminology) for procedural coding.
1. ICD-10-CM
Diagnosis Codes
The diagnosis code sets used for pacemakers are
primarily related to heart conditions requiring pacemaker implantation. Common
ICD-10-CM codes for conditions include:
<!--[if !supportLists]-->·
<!--[endif]-->I44.0 – Atrioventricular block, complete:
A complete block in the electrical conduction system of the heart, which may
require pacemaker therapy.
<!--[if !supportLists]-->·
<!--[endif]-->I49.01 – Sick sinus syndrome: A
condition where the sinus node, responsible for initiating the heart’s rhythm,
is dysfunctional.
<!--[if !supportLists]-->·
<!--[endif]-->I47.2 – Paroxysmal supraventricular tachycardia:
A rapid heart rate originating from the atria, which may require pacemaker
intervention.
<!--[if !supportLists]-->·
<!--[endif]-->I44.2 – Atrioventricular block, first degree:
A condition that could progress to requiring a pacemaker, depending on
severity.
Other related codes will depend on the patient’s
specific medical condition and the reason for the pacemaker implantation.
2. CPT Procedure Codes
The procedure codes used for pacemaker insertion and
related services are found in the CPT coding system. Common CPT codes for pacemaker procedures
include:
<!--[if !supportLists]-->·
<!--[endif]-->33202 – Insertion of a single-chamber pacemaker (implantation
of a pacemaker for the management of certain cardiac conditions).
<!--[if !supportLists]-->·
<!--[endif]-->33203 – Insertion of a dual-chamber pacemaker (used
for more complex cases where both atria and ventricles need pacing).
<!--[if !supportLists]-->·
<!--[endif]-->33206 – Insertion of a biventricular pacemaker (for
heart failure patients requiring resynchronization therapy).
<!--[if !supportLists]-->·
<!--[endif]-->33208 – Insertion of a permanent pacemaker pulse
generator, dual chamber.
<!--[if !supportLists]-->·
<!--[endif]-->33235 – Removal of pacemaker pulse generator and
replacement.
<!--[if !supportLists]-->·
<!--[endif]-->33249 – Insertion of a pacemaker lead (when
adding or replacing pacemaker leads).
<!--[if !supportLists]-->·
<!--[endif]-->33213 – Insertion of pacemaker with endocardial lead
(ventricular).
These codes also extend to services like follow-up
monitoring and device interrogation, which are critical components of pacemaker
management.
3. HCPCS
Codes for Pacemaker Devices
In addition to CPT codes, HCPCS
Level II codes are used to report
pacemaker devices and related supplies. For example:
<!--[if !supportLists]-->·
<!--[endif]-->C1780 – Pacemaker, dual chamber.
<!--[if !supportLists]-->·
<!--[endif]-->C1820 – Pacemaker, single chamber.
<!--[if !supportLists]-->·
<!--[endif]-->C1830 – Biventricular pacemaker.
These codes are important for accurate device
reimbursement and supply tracking.
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.
Billing for
Pacemaker Services
The billing process for pacemaker implantation and
follow-up care is multifaceted. In addition to the correct codes, healthcare
providers must adhere to specific payer guidelines, which can vary by insurer
and the specifics of a patient’s health plan.
1. Inpatient
vs. Outpatient Billing
Pacemaker procedures can be performed either in an
inpatient or outpatient setting, with corresponding differences in billing:
<!--[if !supportLists]-->·
<!--[endif]-->Inpatient
Billing: Pacemaker implants in an
inpatient setting are often part of a larger hospital stay for cardiac care. In
these cases, diagnosis and procedure codes are billed under the Diagnosis-Related
Group (DRG) system, where the DRG code assigned reflects
the overall clinical condition and the care provided during hospitalization.
<!--[if !supportLists]-->·
<!--[endif]-->Outpatient
Billing: If the procedure is performed in
an outpatient or ambulatory surgical center (ASC), the provider typically
uses Revenue Codes in addition to CPT and
ICD-10-CM codes. The outpatient billing may also require modifiers to denote
special circumstances or services, such as Modifier 59 (Distinct
Procedural Service) if separate or unrelated procedures are performed
<!--[if !supportLists]-->·
<!--[endif]-->2.
Device-Related Charges
Pacemaker devices themselves are generally billed
separately from the procedure for implantation. The cost of the pacemaker
device, including leads and generators, is usually represented by HCPCS
Level II codes. These are tied directly to the
cost of the device and should be matched with the appropriate modifier to
indicate whether the device was provided by the facility or physician.
3. Follow-up and Remote Monitoring
After implantation, pacemaker patients typically require
routine follow-up visits to assess the device’s performance. These visits often
involve:
<!--[if !supportLists]-->·
<!--[endif]-->Device
interrogation: A non-invasive process used to
evaluate pacemaker function.
<!--[if !supportLists]-->·
<!--[endif]-->Programming
adjustments: Changes to the device settings to
optimize function.
CPT Code 93279 (Device Interrogation) is
commonly used for billing for these services, as well as CPT
93286 (Remote Patient Monitoring), which is applicable
when the device data is transmitted electronically.
Challenges
in Pacemaker Coding and Billing
While coding and billing for pacemakers are
straightforward in many cases, there are several challenges healthcare
providers may face:
<!--[if !supportLists]-->1.
<!--[endif]-->Device
Documentation: Accurate documentation of the
device type and any changes made during the procedure is crucial for billing. A
discrepancy between the documentation and the billed codes can lead to claim
denials or delays in reimbursement.
<!--[if !supportLists]-->2.
<!--[endif]-->Coding
for Complications: If a patient
experiences complications such as infection or malfunction of the pacemaker,
additional diagnostic codes and procedures may need to be reported. Providers
must ensure that these codes are correctly captured and billed.
<!--[if !supportLists]-->3.
<!--[endif]-->Modifier
Use: In some cases, the use of
modifiers (e.g., Modifier 59, Modifier
51) may be necessary to differentiate between multiple procedures
performed during a single encounter. Incorrect modifier usage can lead to
incorrect payment or denials.
<!--[if !supportLists]-->4.
<!--[endif]-->Payer-Specific
Rules: Insurance companies may have
varying rules regarding pacemaker devices, especially with regard to the
approval and reimbursement of expensive devices or the necessity for
pre-authorization.
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
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