How To Use CPT Code 33221

CPT 33221 describes the insertion of a pacemaker pulse generator in a patient with existing multiple leads. This article will cover the description, procedure, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information and billing examples.

1. What is CPT Code 33221?

CPT 33221 can be used to describe the procedure of inserting a pacemaker pulse generator in a patient who already has multiple leads in place. This code is used when the provider creates a subcutaneous pocket in the patient’s chest and places the new generator in the pocket. The procedure is primarily performed to regulate heart beats in patients with arrhythmia.

2. Official Description

The official description of CPT code 33221 is: ‘Insertion of pacemaker pulse generator only; with existing multiple leads.’

3. Procedure

1. The provider makes an incision on the skin in the subclavicular region, extending to the subpectoral region.
2. A subcutaneous pocket is created in the pectoralis fascia or just below the pectoral muscle.
3. The ends of the existing leads are freed from fibrous adhesions and protected from damage.
4. The pocket is irrigated with saline to clean it.
5. The new generator for the multiple lead system is placed into the pocket.
6. The existing lead is tested for proper functionality and attached to the new pulse generator.
7. The skin pocket is closed with sutures, staples, or tissue adhesive.
8. The provider programs the device for functionality.

4. Qualifying circumstances

CPT 33221 is used when the patient already has multiple leads in at least three chambers of the heart. The procedure is performed for patients with arrhythmia who require artificial regulation of heart beats. It is important to note that CPT 33221 should not be reported in conjunction with certain other codes, as specified in the notes.

5. When to use CPT code 33221

CPT code 33221 should be used when the provider is inserting a pacemaker pulse generator in a patient with existing multiple leads. It should not be used for replacement services, as there are specific codes for that purpose. It is important to review the notes and guidelines to ensure accurate reporting of the procedure.

6. Documentation requirements

To support a claim for CPT 33221, the provider must document the following information:

• Patient’s diagnosis and the need for the pacemaker pulse generator insertion
• Details of the procedure, including the location of the incision and the creation of the subcutaneous pocket
• Confirmation of the existing multiple leads and their placement in the heart chambers
• Description of the testing and attachment of the existing lead to the new pulse generator
• Method of closure for the skin pocket
• Programming of the device for functionality

7. Billing guidelines

When billing for CPT 33221, ensure that the procedure meets the criteria for the code, including the presence of existing multiple leads. Review the notes and guidelines to determine if any other codes should be reported in conjunction with CPT 33221. It is important to accurately report the radiological supervision and interpretation related to the procedure as well.

8. Historical information

CPT 33221 was added to the Current Procedural Terminology system on January 1, 2012. There have been no updates to the code since its addition.

9. Examples

1. A cardiologist inserts a pacemaker pulse generator in a patient who already has leads in three chambers of the heart.
2. An electrophysiologist performs the procedure of placing a new pulse generator in a patient with existing multiple leads for the regulation of heart beats.
3. A cardiac surgeon creates a subcutaneous pocket and inserts a pacemaker pulse generator in a patient with multiple leads in place.
4. A cardiac nurse assists the provider in testing the existing lead and attaching it to the new pulse generator during the procedure of inserting a pacemaker pulse generator in a patient with existing multiple leads.
5. An interventional cardiologist programs the device for functionality after inserting a pacemaker pulse generator in a patient with multiple leads in three chambers of the heart.
6. A cardiac technician documents the details of the procedure, including the location of the incision and the creation of the subcutaneous pocket, during the insertion of a pacemaker pulse generator in a patient with existing multiple leads.
7. A cardiovascular surgeon closes the skin pocket with sutures after inserting a pacemaker pulse generator in a patient with multiple leads in place.
8. A cardiac electrophysiologist reviews the radiological supervision and interpretation related to the procedure of inserting a pacemaker pulse generator in a patient with existing multiple leads.
9. A cardiac nurse documents the programming of the device for functionality after the insertion of a pacemaker pulse generator in a patient with multiple leads in three chambers of the heart.
10. An interventional radiologist assists the provider in the creation of the subcutaneous pocket for lodging the pacemaker pulse generator in a patient with existing multiple leads.