How To Use CPT Code 33225

CPT 33225 refers to the insertion of a pacing electrode for left ventricular pacing during the insertion of an implantable defibrillator or pacemaker pulse generator. This article will cover the description, procedure, qualifying circumstances, usage, documentation requirements, billing guidelines, historical information, similar codes, and examples of CPT 33225.

1. What is CPT 33225?

CPT 33225 is a medical procedure code that describes the insertion of a pacing electrode into the cardiac venous system for left ventricular pacing during the insertion of an implantable defibrillator or pacemaker pulse generator. This procedure is typically performed to upgrade a patient’s pacemaker to a dual chamber system.

2. 33225 CPT code description

The official description of CPT code 33225 is: “Insertion of pacing electrode, cardiac venous system, for left ventricular pacing, at time of insertion of implantable defibrillator or pacemaker pulse generator (eg, for upgrade to dual chamber system) (List separately in addition to code for primary procedure)”.

3. Procedure

The 33225 procedure involves the following steps:

1. The patient is appropriately prepped and anesthetized.
2. During the same session as the provider inserts a new pacemaker or implantable defibrillator, the provider places a new electrode for left ventricle pacing.
3. The pacing electrode lead is introduced through a vein, usually the internal jugular or subclavian vein, and advanced under fluoroscopic guidance to the left ventricle.
4. The provider ensures that the pacing electrode is in the correct position over the left ventricle.
5. The left ventricular lead is attached to the new dual pacemaker generator.
6. The cardiac device pocket is closed.

4. Qualifying circumstances

Patients eligible to receive CPT code 33225 services are those with sick sinus syndrome, arterioventricular block, or both, who require an upgrade to a dual chamber pacemaker system. This procedure is performed during the insertion of an implantable defibrillator or pacemaker pulse generator.

5. When to use CPT code 33225

It is appropriate to bill the 33225 CPT code when the provider inserts a pacing electrode for left ventricular pacing during the insertion of an implantable defibrillator or pacemaker pulse generator. This procedure is typically performed to upgrade a patient’s pacemaker to a dual chamber system.

6. Documentation requirements

To support a claim for CPT 33225, the following information should be documented:

• Patient’s medical history and diagnosis, including the presence of sick sinus syndrome, arterioventricular block, or both.
• Indication for the procedure, such as the need for an upgrade to a dual chamber pacemaker system.
• Details of the procedure, including the insertion of the pacing electrode and attachment to the dual pacemaker generator.
• Any complications or additional interventions performed during the procedure.
• Post-procedure care and follow-up instructions.

7. Billing guidelines

When billing for CPT code 33225, it is important to remember that it is an add-on code and should be reported in conjunction with an appropriate primary code. The primary codes include pacemaker or pacing cardioverter-defibrillator procedure codes: 33206 to 33208, 33212 to 33214, 33216, 33217, 33221 to 33223, 33228 to 33231, 33233 to 33235, 33240, 33249, 33263, and 33264. Additionally, ensure that all required documentation is included to support the claim.

8. Historical information

CPT 33225 was added to the Current Procedural Terminology system on January 1, 2003. There have been several updates to the code since its addition, with the most recent change occurring on January 1, 2015.

9. Similar codes to CPT 33225

Five similar codes to CPT 33225 and how they differentiate are:

1. CPT 33206: This code refers to the insertion of a single chamber pacemaker pulse generator, without the additional pacing electrode for left ventricular pacing.
2. CPT 33212: This code describes the insertion of a dual chamber pacemaker pulse generator, without the additional pacing electrode for left ventricular pacing.
3. CPT 33221: This code refers to the insertion of a pacing cardioverter-defibrillator pulse generator only, without the additional pacing electrode for left ventricular pacing.
4. CPT 33230: This code describes the insertion of a pacing cardioverter-defibrillator pulse generator with single or dual chamber pacing, without the additional pacing electrode for left ventricular pacing.
5. CPT 33249: This code refers to the insertion or replacement of a pacing cardioverter-defibrillator pulse generator with existing single or dual chamber leads, without the additional pacing electrode for left ventricular pacing.

10. Examples

Here are 10 detailed examples of CPT code 33225 procedures:

1. A patient with sick sinus syndrome undergoes the insertion of a dual chamber pacemaker pulse generator, with the additional pacing electrode for left ventricular pacing.
2. A patient with arterioventricular block receives an implantable defibrillator, with the additional pacing electrode for left ventricular pacing during the same procedure.
3. A patient with both sick sinus syndrome and arterioventricular block undergoes an upgrade to a dual chamber pacemaker system, with the insertion of the pacing electrode for left ventricular pacing.
4. A patient with a history of heart failure receives a new implantable defibrillator, with the additional pacing electrode for left ventricular pacing during the same procedure.
5. A patient with a previously implanted single chamber pacemaker undergoes an upgrade to a dual chamber system, with the insertion of the pacing electrode for left ventricular pacing.
6. A patient with a previously implanted dual chamber pacemaker receives a new implantable defibrillator, with the additional pacing electrode for left ventricular pacing during the same procedure.
7. A patient with a history of recurrent ventricular arrhythmias undergoes the insertion of a pacing cardioverter-defibrillator pulse generator, with the additional pacing electrode for left ventricular pacing.
8. A patient with a previously implanted pacing cardioverter-defibrillator receives an upgrade to a dual chamber system, with the insertion of the pacing electrode for left ventricular pacing.
9. A patient with a history of syncope due to bradycardia undergoes the insertion of a dual chamber pacemaker pulse generator, with the additional pacing electrode for left ventricular pacing.
10. A patient with a previously implanted single chamber defibrillator undergoes an upgrade to a dual chamber system, with the insertion of the pacing electrode for left ventricular pacing.