How To Use CPT Code 33249

CPT 33249 refers to the insertion or replacement of a permanent implantable defibrillator system with single or dual chamber transvenous leads. This article will cover the description, procedure, qualifying circumstances, usage, documentation requirements, billing guidelines, historical information, similar codes, and examples of CPT 33249 procedures.

1. What is CPT 33249?

CPT 33249 is a medical billing code used to describe the insertion or replacement of a permanent implantable defibrillator system with single or dual chamber transvenous leads. This code is used by medical professionals to accurately document and bill for this specific procedure, ensuring proper reimbursement and accurate record-keeping.

2. 33249 CPT code description

The official description of CPT code 33249 is: “Insertion or replacement of permanent implantable defibrillator system, with transvenous lead(s), single or dual chamber.”

3. Procedure

The CPT 33249 procedure involves the following steps:

1. The patient is appropriately prepped and anesthetized.
2. An incision is made at the selected site.
3. If a previously implanted defibrillator system is present, the provider opens the pocket and disconnects the leads to replace the generator. If not, a generator is placed in a newly created pocket.
4. A catheter is threaded through a vein, and fluoroscopy may be used to guide the electrode catheter to the appropriate chambers of the heart.
5. The leads are inserted through the catheter and placed in the desired heart chambers. For a single chamber system, a lead is placed in the right ventricle. For a dual chamber system, leads are placed in the right ventricle and atrium.
6. The leads are attached to the pulse generator in the prepared pocket, and the function of the system is evaluated.
7. The provider checks for bleeding, removes all instruments, and closes the incision in the chest.

4. Qualifying circumstances

Patients eligible to receive CPT 33249 services are those who require a permanent implantable defibrillator system due to a history of life-threatening ventricular arrhythmias, or those at high risk for sudden cardiac death. This may include patients with a history of heart failure, cardiomyopathy, or other conditions that put them at risk for dangerous heart rhythms. A thorough evaluation by a healthcare provider is necessary to determine if a patient is a suitable candidate for this procedure.

5. When to use CPT code 33249

CPT code 33249 should be used when a healthcare provider performs the insertion or replacement of a permanent implantable defibrillator system with single or dual chamber transvenous leads. This code is appropriate for billing and documentation purposes when the procedure is medically necessary and meets the qualifying circumstances outlined above.

6. Documentation requirements

To support a claim for CPT 33249, the following information should be documented:

• Patient’s medical history and indication for the procedure
• Details of the procedure, including the type of defibrillator system used (single or dual chamber) and the method of lead placement
• Any complications or difficulties encountered during the procedure
• Post-procedure evaluation of the defibrillator system’s function
• Follow-up care and instructions provided to the patient

7. Billing guidelines

When billing for CPT 33249, it is important to follow the appropriate guidelines and rules to ensure accurate reimbursement. This includes not reporting CPT 33249 in conjunction with CPT 33216 or CPT 33217. For removal and replacement of an implantable defibrillator pulse generator and transvenous electrode(s), use CPT 33241 in conjunction with either CPT 33243 or CPT 33244 and CPT 33249. For insertion of transvenous implantable defibrillator lead(s) without thoracotomy, use CPT 33216 or CPT 33217.

8. Historical information

CPT 33249 was added to the Current Procedural Terminology system on January 1, 1994. The code has undergone several changes since its introduction, with the most recent change occurring on January 1, 2015, when the descriptor was updated to its current form.

9. Similar codes to CPT 33249

Five similar codes to CPT 33249 and how they differ are:

• CPT 33241: This code is used for the removal of an implantable defibrillator pulse generator, without lead removal or replacement.
• CPT 33243: This code is used for the removal of single or dual chamber implantable defibrillator electrode(s) by thoracotomy.
• CPT 33244: This code is used for the removal of single or dual chamber implantable defibrillator electrode(s) by transvenous extraction.
• CPT 33216: This code is used for the insertion of a single transvenous electrode for an implantable defibrillator, without thoracotomy.
• CPT 33217: This code is used for the insertion of dual transvenous electrodes for an implantable defibrillator, without thoracotomy.

10. Examples

Here are 10 detailed examples of CPT code 33249 procedures:

1. A patient with a history of ventricular tachycardia undergoes the insertion of a single chamber implantable defibrillator system with transvenous lead.
2. A patient with dilated cardiomyopathy has a dual chamber implantable defibrillator system with transvenous leads replaced due to battery depletion.
3. A patient with a history of sudden cardiac arrest receives a new dual chamber implantable defibrillator system with transvenous leads.
4. A patient with a previously implanted single chamber defibrillator system undergoes a generator replacement due to malfunction.
5. A patient with a history of heart failure and recurrent ventricular fibrillation has a single chamber implantable defibrillator system with transvenous lead inserted.
6. A patient with hypertrophic cardiomyopathy undergoes the insertion of a dual chamber implantable defibrillator system with transvenous leads.
7. A patient with a history of ventricular tachycardia and a previously implanted defibrillator system undergoes a generator replacement due to infection.
8. A patient with a history of recurrent ventricular fibrillation receives a new single chamber implantable defibrillator system with transvenous lead.
9. A patient with a previously implanted dual chamber defibrillator system undergoes a generator replacement due to battery depletion.
10. A patient with a history of heart failure and recurrent ventricular tachycardia has a dual chamber implantable defibrillator system with transvenous leads inserted.