Billing accuracy directly impacts your practice’s financial health. For high-paying medical specialties, such as cardiology, accurate coding becomes even more essential. One rejected claim can turn into a revenue loss of hundreds or even thousands of dollars. Do you know that the average cost to rework a claim is $25 for small practices and $181 for hospitals, as cited in the Journal of AHIMA?
CPT code 33208 is a frequently used high-paying cardiology code. Yet, billers make many mistakes while filing claims for it. So, how can you bill 33208 correctly? Well, we have created this detailed guide to answer this question.
CPT Code 33208 – Description
CPT code 33208 is defined as:
“Insertion of new or replacement of permanent pacemaker with transvenous electrode(s); atrial and ventricular.”
The definition is self-explanatory. However, to better understand the code usage, let’s try to break this down in simpler terms.
33208 represents the insertion or replacement of a permanent pacemaker with transvenous electrodes implanted in the right atrium and right ventricle. This is commonly called dual-chamber pacemaker implantation.
Please note that it is a significant surgical procedure and involves the administration of local anesthesia. However, CPT code 33208 does not include the reimbursement for anesthesia, and it must be billed separately.
The dual-chamber pacemaker is a very effective heart device. It provides synchronized pacing to both the right ventricle and atrium. This results in improved hemodynamic function, a reduced risk of pacemaker syndrome, and a better quality of life for patients.
Scenarios Where CPT Code 33208 is Applicable
Knowing when to use a code and when not to is essential if you want to avoid claim denials. So, when should you consider using CPT 33208? The following are some medically valid scenarios in which 33208 can be used:
Medicare Covered Indications
Medicare allows the use of CPT code 33208 when a dual-chamber pacemaker is inserted or replaced for a patient with the following conditions:
- Documented non-reversible symptomatic bradycardia due to sinus node dysfunction
- Documented non-reversible symptomatic bradycardia due to second or third-degree atrioventricular (AV) block
- Complete third-degree AV block with or without symptoms
- Symptomatic second-degree AV block (Mobitz type II)
Additional Covered Conditions
- Symptomatic first-degree AV block with PR interval >300 milliseconds
- Bundle branch blocks with symptomatic presentations
- Atrial fibrillation with symptomatic bradycardia
- Hypersensitive carotid sinus syndrome with documented asystole ≥3 seconds
Applicable Modifiers for CPT Code 33208
CPT code 33208 claims require the use of appropriate modifiers to justify the medical necessity of the procedure. The following are some frequently used modifiers with 33208:
| Modifier | Description | Usage Scenario |
|---|---|---|
| KX | Requirements specified in the medical policy have been met | Covered diagnoses meeting NCD criteria |
| SC | Medically necessary service or supply | Conditions not addressed by NCD but medically necessary |
| GA | Waiver of liability statement issued | Expected denial with signed ABN |
| GZ | Expected denial without ABN | Non-covered services without patient notification |
An important point that billers must note is that insurance claims for the insertion or replacement of pacemakers that do not meet the criteria for modifier SC or KX will most probably be denied. Unless the appropriate GZ or GA modifiers are applied and a proper Advanced Beneficiary Notice is provided.
CPT Code 33208 – Billing & Reimbursement Guidelines
Are denials for CPT code 33208 getting out of hand? You might be missing vital billing requirements and guidelines. Here’s what to keep in mind:
Meet the Documentation Requirements
You must append comprehensive documentation with CPT code 33208 claims. For 33208, make sure to include the following:
- A detailed record of the patient, including identification like full name, age, policy number, etc.
- Service date.
- Operative notes with an authentic and clear signature of the physician and/or non-physician practitioner who delivered the service.
- ICD-10-CM code(s) to substantiate the medical necessity of the procedure.
Be Wary of the Global Period
CPT code 33208 is a surgical procedure and has a global period of 90 days. The reimbursement division percentage for pre-operative, intra-operative, and post-operative services is:
- Pre-OP: 0.09 (9% of the total payment)
- Intra-OP: 0.84 (84% of total payment)
- Post-OP: 0.07 (7% of the total payment)
Do Not Use 33208 for Non-Covered Indications
Medicare specifically excludes certain conditions from coverage:
- Reversible causes of bradycardia (medications, electrolyte imbalances)
- Asymptomatic bradycardia conditions
- Syncope of undetermined cause
- Bradycardia during sleep
Verify the Reimbursement Amount
The reimbursement amount for CPT code 33208 is heavily influenced by MAC localities and the specific part of the procedure (pre-, intra-, and post-operative). Medicare’s national average reimbursement for 33208 in facility settings is $494.90. You can check the exact amount for your MAC locality via the PFS Lookup Tool.
The following table provides a more detailed breakdown of the cost:
| Cost Component | Ambulatory Surgical Centers (ASC) | Hospital Outpatienxt Departments | Cost Difference (Hospital OPD – ASC) |
|---|---|---|---|
| Total Cost | $8,183 | $10,959 | $2,776 |
| Physician Fee | $494 | $494 | $0 |
| Facility Fee | $7,689 | $10,465 | $2,776 |
| Medicare Pays | $6,546 | $9,184 | $2,638 |
| Patient Pays | $1,635 | $1,774 | $139 |
Source: Medicare.gov
Wrapping Up
Ready to tackle payers’ billing demands for dual-chamber pacemaker insertions? We hope that you can now confidently file claims for CPT code 33208. Let’s do a quick recap in case you have missed something.
33208 refers to a cardiac surgery procedure that is performed to insert or replace a dual-chamber pacemaker with transvenous electrodes. The procedure has a global period of 90 days and must be supported with relevant modifiers and documentation.
However, if you are still unprepared for payer audits, hand over everything to a professional medical biller. You can find many companies that offer specialized cardiology billing services at very affordable prices.
