How To Use CPT Code 33228

CPT 33228 refers to the removal and replacement of a permanent pacemaker pulse generator in a dual lead system. This article will cover the description, procedure, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information, similar codes, and examples of CPT 33228 procedures.

1. What is CPT 33228?

CPT 33228 is a medical procedure code that describes the removal of a permanent pacemaker pulse generator and its replacement with a new one in a dual lead system. This procedure is primarily performed for patients with arrhythmia, an irregular heart rhythm, who require artificial regulation of their heartbeats by the device.

2. 33228 CPT code description

The official description of CPT code 33228 is: “Removal of permanent pacemaker pulse generator with replacement of pacemaker pulse generator; dual lead system.”

3. Procedure

1. The patient is appropriately prepped and anesthetized.
2. The provider makes an incision on the skin of the subcutaneous pocket enclosing the existing generator.
3. The existing generator is freed from the fibrous adhesions surrounding it, and the leads are separated from the extensive fibrous adhesions in the pocket, taking care to protect the leads from any damage.
4. The existing leads are tested for proper functionality.
5. If needed, the existing skin pocket is adapted to the dimensions of the new generator.
6. The pocket is cleaned by irrigating it with saline.
7. The new generator for the dual lead system is placed into the pocket and attached to the existing leads.
8. Hemostasis, or stoppage of bleeding, is achieved.
9. The skin pocket is closed with sutures, staples, or tissue adhesive.
10. The provider programs the device for functionality.

4. Qualifying circumstances

Patients eligible to receive CPT code 33228 services are those with a previously placed permanent pacemaker pulse generator in a dual lead system who require removal and replacement of the generator due to device malfunction, battery depletion, or other medical reasons. The provider must determine that the existing leads are still functional and appropriate for the new generator.

5. When to use CPT code 33228

It is appropriate to bill the 33228 CPT code when the provider removes a permanent pacemaker pulse generator in a dual lead system and replaces it with a new one, ensuring that the existing leads are functional and compatible with the new generator. This code should not be used if the provider is only removing the generator without replacement or if the procedure involves a single lead system.

6. Documentation requirements

To support a claim for CPT 33228, the provider must document the following information in the patient’s medical record:

• Indication for the removal and replacement of the pacemaker pulse generator, such as device malfunction or battery depletion.
• A detailed description of the procedure, including the steps taken to remove the existing generator, test the leads, and insert the new generator.
• Confirmation that the existing leads are functional and compatible with the new generator.
• Postoperative programming of the device and verification of its functionality.

7. Billing guidelines

When billing for CPT code 33228, it is important to follow the appropriate guidelines and rules. This code includes radiological supervision and interpretation related to the procedure. If the provider removes a dual lead device, caps one lead, places it in the pocket, and attaches the other lead to the new device, CPT code 33227 should be reported instead of 33228.

8. Historical information

CPT 33228 was added to the Current Procedural Terminology system on January 1, 2012. There have been no updates to the code since its addition.

9. Similar codes to CPT 33228

Five similar codes to CPT 33228 and how they differentiate are:

1. CPT 33227: Involves the removal and replacement of a pacemaker pulse generator in a dual lead system, but with one lead capped and placed in the pocket.
2. CPT 33229: Describes the removal and replacement of a pacemaker pulse generator in a single lead system.
3. CPT 33230: Refers to the insertion of a pacing electrode in the right atrium, including connection to an existing generator.
4. CPT 33231: Involves the insertion of a pacing electrode in the right ventricle, including connection to an existing generator.
5. CPT 33240: Describes the insertion of an implantable defibrillator pulse generator only, without any lead placement.

10. Examples

Here are 10 detailed examples of CPT code 33228 procedures:

1. A patient with a history of atrial fibrillation requires removal and replacement of their dual lead pacemaker pulse generator due to battery depletion.
2. A patient with a dual lead pacemaker experiences device malfunction, necessitating removal and replacement of the pulse generator.
3. A patient with a dual lead pacemaker system undergoes removal and replacement of the pulse generator as part of a planned upgrade to a newer device model.
4. A patient with a dual lead pacemaker requires removal and replacement of the pulse generator due to infection at the generator site.
5. A patient with a dual lead pacemaker experiences intermittent loss of pacing, leading to the removal and replacement of the pulse generator.
6. A patient with a dual lead pacemaker undergoes removal and replacement of the pulse generator due to a manufacturer recall.
7. A patient with a dual lead pacemaker requires removal and replacement of the pulse generator due to a broken or damaged device.
8. A patient with a dual lead pacemaker experiences syncope, and diagnostic testing reveals the need for removal and replacement of the pulse generator.
9. A patient with a dual lead pacemaker undergoes removal and replacement of the pulse generator as part of a clinical trial evaluating new device technology.
10. A patient with a dual lead pacemaker requires removal and replacement of the pulse generator due to the development of a pocket hematoma.