Medical billing is a demanding task for many healthcare providers, especially for cardiologists who deal with such an intricate organ of the body (heart). Their job demands attention to detail and complete concentration. The complexity of medical billing further burdens them. So we have decided to lend a hand and provide essential guidelines on medical billing for cardiology services.
This blog unfolds the billing details of CPT code 33249. The code represents the insertion of an electronic device designed to detect and regulate heart rate under life-threatening situations. As a healthcare provider, you must accurately bill and document this code to receive fair compensation.
CPT Code 33249 – Description
CPT code 33249 describes a procedure where a permanent cardioverter-defibrillator (ICD) system is implanted or replaced. The device has one or two transvenous leads and a pulse generator.
This ICD device detects and corrects irregular cardiac rhythms. Hence, it is placed under the chest skin and is connected to the heart through the veins.
Now, if you are wondering how this device works and its real purpose, then let us tell you. These defibrillators provide a mild electric shock to the heart to automatically stabilize the arrhythmia when they sense an abnormal heart rate. The purpose of this device is to administer life-saving shocks, restore normal cardiac rhythm, and prevent abrupt cardiac arrest.
Scenarios Where CPT Code 33249 is Applicable
The following are some scenarios where the physicians implant/replace a permanent ICD system and report the procedure with CPT code 33249.
Cardiac Arrest
Suppose a 58-year-old male has a history of damaged heart muscles due to poor blood supply and a severely reduced left ventricular ejection fraction (LVEF) rate of less than 30%. His cardiologist suspects that he might suffer from a fatal arrhythmia. The physician performs an ICD implantation (covered by CPT code 33249) and advances a transvenous lead into the heart chamber to monitor the patient’s heart rhythm continuously and save him from a sudden heart attack.
Arrhythmia
Imagine an elderly man in his early 70s who often suffers from arrhythmia episodes, which include dangerously fast and irregular heartbeats. His physician advised implanting a cardioverter-defibrillator (ICD) system to prevent abrupt cardiac arrests. Therefore, after the patient’s approval, the physician surgically implants an ICD device with transvenous leads being advanced into the heart chambers. This ICD device will identify the irregular rhythm in a matter of seconds and send a controlled electrical shock to bring his heartbeat back to normal. Hence, the procedure will be reported with CPT code 33249 for billing purposes.
Ventricular Fibrillation
Consider a 62-year-old woman who is currently at risk of potential cardiac arrest due to her history of non-ischemic cardiomyopathy and her 28% ejection fraction. For primary prophylaxis, her cardiologist suggested an implanted cardioverter-defibrillator (ICD). Therefore, the patient undergoes an ICD implantation, which includes inserting the device and transvenous leads in place to continuously monitor her heart rhythm. In this case, CPT code 33249 can be reported.
Applicable Modifiers for CPT Code 33249
The following are some applicable modifiers for CPT code 33249.
Modifier 22
Modifier 22 refers to increased services, such as spending extra time or effort during the procedure. So, you can apply modifier 22 to CPT code 33249 if you are dealing with a patient’s variant anatomy that makes lead placement more difficult or a patient’s severe condition requiring increased effort.
Modifier KZ
Modifier KZ refers to the service being billed for new coverage that has not been published in the policies of the managed care plan or formally implemented yet. Add the KZ modifier to the claim for CPT code 33249 to specify that the procedure is covered by a new coverage category that the managed care payer (Medicare) has not yet adopted.
Modifier Q0
The Q0 modifier indicates an investigational clinical service that is being submitted for Medicare review and is part of a research objective. The service is rendered inside an authorized clinical research project. However, modifier Q0 applies to CPT code 33249 if the healthcare professional implants an ICD device for congestive heart failure (CHF) or cardiomyopathy. Furthermore, to prevent Medicare from denying your claim, think about the likelihood that you might need to provide the 8-digit clinical trial (CT) registration number.
CPT Code 33249 – Billing & Reimbursement Guidelines
The following billing guidelines for CPT code 33249 can help healthcare providers in submitting accurate claims.
Submit Supporting Documentation
Did you know that a high number of claims are denied due to improper documentation? Centers for Medicare & Medicaid Services (CMS) found that approximately 85% of improper payments relating to the billing of implantable automatic defibrillators were due to insufficient documentation. This happens when the biller fails to accurately mention details about the procedure. There is some essential information that you can not miss in your paperwork. It includes:
- Physician’s signature on the procedure note
- Attestation for cases in which the physician’s signature is required
- Hospital records
- Specified date of service
- Clinical indication for the procedure (e.g., ICD-10 codes or test reports)
- Proof that the beneficiary was enrolled in a clinical study/trial (if applicable)
Be Wary of the Global Days
A global time period in medical billing denotes the number of days for which a global surgical package is set by Medicare. It is a predetermined time frame that covers pre-, intra-, and post-operative treatments. Medicare releases a combined payment for this entire period. CPT code 32249 represents a 90-day global period. Therefore, the payment will cover the procedure itself and any services that were rendered before and after the surgery (for 90 days from the date of surgery).
Review Payers’ Policies
Every insurance payer sets their own rules to reimburse particular services. Similarly, Medicare has specified some rules that it will only cover ICD system implantation if the following conditions are met:
- If your patient has a life-threatening fast heart rhythm (ventricular tachyarrhythmia – VT), or a cardiac arrest caused by ventricular fibrillation (VF).
- Patients with a history of heart attack (MI), and their heart’s pumping ability (LVEF) must be 30% or less.
- Patients with a severely damaged heart muscle due to poor blood supply.
- People with genetic conditions like long QT syndrome or hypertrophic cardiomyopathy which put them at high risk for dangerous heart rhythms.
Conclusion
We have covered every important element about CPT code 33249. In summary, this code is associated with an ICD system that monitors, senses, and controls heart rate by administering a moderate electric shock when necessary. We have discussed some examples and modifiers, such as Q0 and KZ, to illustrate this description in real-world clinical settings.
We also discussed the medical billing and reimbursement guidelines, such as highlighting the varying payer policies and essential documentation requirements.
If you are still having trouble billing for CPT code 33249, we advise you to get professional assistance from companies that offer cardiology billing services. Their staff will support and mentor you on the billing procedure.
