How To Use CPT Code 33231

CPT 33231 describes the insertion of an implantable defibrillator pulse generator only, 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 33231?

CPT 33231 is used to describe the procedure of inserting an implantable defibrillator pulse generator in a patient who already has multiple leads in their heart. This code is specifically used when the provider is only inserting the pulse generator and not performing any other related procedures.

2. Official Description

The official description of CPT code 33231 is: ‘Insertion of implantable defibrillator pulse generator only; with existing multiple leads.’

3. Procedure

1. The provider begins by making an incision in the subclavicular region, below the collarbone, and extends it to the subpectoral region, in the front of the chest near the armpit.
2. Next, the provider creates a subcutaneous pocket in the pectoralis fascia or just below the pectoral muscle to place the new pulse generator.
3. The existing leads are carefully freed from any fibrous adhesions surrounding them to avoid damage.
4. The provider then irrigates the pocket with saline to ensure cleanliness.
5. The new pulse generator for the multiple lead device is placed into the pocket, and the existing leads are attached to it.
6. After achieving hemostasis, the provider closes the skin pocket using sutures, staples, or tissue adhesive.
7. Finally, the provider programs the device for functionality.

4. Qualifying circumstances

CPT 33231 is used when a patient already has multiple leads in their heart and requires the insertion of a new implantable defibrillator pulse generator. This procedure is typically performed for patients with arrhythmia, an irregular heart rhythm, to regulate their heart rate using the device.

5. When to use CPT code 33231

CPT code 33231 should be used when the provider is only inserting the implantable defibrillator pulse generator and not performing any other related procedures. If the patient has dual leads or a single lead, different codes should be used (33230 for dual leads and 33240 for a single lead).

6. Documentation requirements

To support a claim for CPT 33231, the provider must document the following information:

• Confirmation of the patient’s existing multiple leads
• Details of the procedure, including the incision sites and creation of the subcutaneous pocket
• Confirmation of proper attachment of the existing leads to the new pulse generator
• Method of closure for the skin pocket (sutures, staples, or tissue adhesive)
• Programming of the device for functionality

7. Billing guidelines

When billing for CPT 33231, ensure that the procedure involves the insertion of an implantable defibrillator pulse generator with existing multiple leads. It should not be reported in conjunction with other codes for related procedures, such as removal and replacement of the pulse generator. Additional tips for accurate billing may be provided by the payer or coding guidelines.

8. Historical information

CPT 33231 was added to the Current Procedural Terminology system on January 1, 2012. There have been no updates or changes to the code since its addition.

9. Examples

1. A cardiologist inserts a new implantable defibrillator pulse generator for a patient with existing leads in all four chambers of the heart.
2. An electrophysiologist performs the procedure to place a new pulse generator in a patient who already has multiple leads for the treatment of arrhythmia.
3. A cardiac surgeon inserts an implantable defibrillator pulse generator in a patient with existing leads in the atrium and ventricle of the heart.
4. A cardiac electrophysiologist performs the procedure to replace the pulse generator in a patient with existing multiple leads.
5. An interventional cardiologist inserts a new pulse generator for a patient with existing leads in the right atrium and ventricle.
6. A cardiothoracic surgeon performs the procedure to place a new implantable defibrillator pulse generator in a patient with existing leads in the left ventricle and right atrium.
7. An electrophysiologist inserts a new pulse generator for a patient with existing leads in the atrium, ventricle, and coronary sinus.
8. A cardiac surgeon performs the procedure to replace the pulse generator in a patient with existing multiple leads in the heart.
9. An interventional cardiologist inserts a new implantable defibrillator pulse generator for a patient with existing leads in the right atrium and ventricle.
10. A cardiothoracic surgeon performs the procedure to place a new pulse generator in a patient with existing leads in the left ventricle and right atrium.