How To Use CPT Code 33240

CPT 33240 describes the insertion of an implantable defibrillator pulse generator only, specifically for patients with an existing single lead. 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 33240?

CPT 33240 is used to describe the procedure of inserting an implantable defibrillator pulse generator for patients who already have a single lead in one chamber of the heart. This code is specifically used when the provider places a new generator in a subcutaneous pocket in the front of the patient’s chest.

2. Official Description

The official description of CPT code 33240 is: ‘Insertion of implantable defibrillator pulse generator only; with existing single lead.’

3. Procedure

1. The provider makes an incision in the subclavicular region, extending it to the subpectoral region.
2. A subcutaneous pocket is created in the pectoralis fascia or just below the pectoral muscle.
3. The existing lead is freed from fibrous adhesions and protected from damage.
4. The pocket is cleaned by irrigating it with saline.
5. The new generator for the single lead device is placed into the pocket.
6. The existing lead is tested for proper functionality and attached to the new pulse generator.
7. The provider achieves hemostasis and closes the skin pocket with sutures, staples, or tissue adhesive.
8. The device is programmed for functionality.

4. Qualifying circumstances

CPT 33240 is performed for patients who require artificial regulation of their heart rate due to arrhythmia, which is an irregular heart rhythm. The procedure is specifically done for patients who already have a single lead in one chamber of the heart.

5. When to use CPT code 33240

CPT code 33240 should be used when the provider inserts an implantable defibrillator pulse generator for a patient with an existing single lead. It should not be reported in conjunction with codes 33271, 93260, or 93261. If the provider also performs the insertion of the generator during the same session as the epicardial lead placement, CPT 33240 should be used in addition to the appropriate epicardial lead placement codes.

6. Documentation requirements

To support a claim for CPT 33240, the provider must document the following information:

• Patient’s diagnosis and the need for the implantable defibrillator pulse generator
• Details of the procedure, including the incision, creation of the subcutaneous pocket, and attachment of the existing lead to the new pulse generator
• Date of the procedure
• Signature of the provider performing the procedure

7. Billing guidelines

When billing for CPT 33240, ensure that the procedure is performed for a patient with an existing single lead. Do not report CPT 33240 in conjunction with codes 33271, 93260, or 93261. If the provider also performs the insertion of the generator during the same session as the epicardial lead placement, use CPT 33240 in addition to the appropriate epicardial lead placement codes.

8. Historical information

CPT 33240 was added to the Current Procedural Terminology system on January 1, 1994. There have been two code changes since its addition, with the most recent change occurring on January 1, 2015.

9. Examples

1. A cardiologist inserting a new implantable defibrillator pulse generator for a patient with an existing single lead in the ventricle.
2. An electrophysiologist performing the procedure to place a new pulse generator for a patient with an existing single lead in the atrium.
3. A cardiac surgeon inserting a new implantable defibrillator pulse generator for a patient with an existing single lead in the ventricle, along with the revision and relocation of the skin pocket.
4. An interventional cardiologist performing the procedure to place a new pulse generator for a patient with an existing single lead in the atrium, including the replacement of the existing generator.
5. A cardiac electrophysiologist inserting a new implantable defibrillator pulse generator for a patient with an existing single lead in the ventricle, along with the revision and relocation of the skin pocket and replacement of the generator.