How To Use CPT Code 33274

CPT 33274 describes the transcatheter insertion or replacement of a permanent leadless pacemaker in the right ventricle. 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 33274?

CPT 33274 is used to describe the procedure of inserting or replacing a permanent leadless pacemaker in the right ventricle. This code includes imaging guidance, such as fluoroscopy, venous ultrasound, ventriculography, and femoral venography, as well as device evaluation or programming when performed. The pacemaker is a cylindrical device that is implanted in the endocardium of the ventricle and can sense heart rate and rhythm, as well as stimulate contractions. It consists of a generator with a built-in battery and an electrode that is inserted via a catheter.

2. Official Description

The official description of CPT code 33274 is: ‘Transcatheter insertion or replacement of permanent leadless pacemaker, right ventricular, including imaging guidance (e.g., fluoroscopy, venous ultrasound, ventriculography, femoral venography) and device evaluation (e.g., interrogation or programming), when performed.’

3. Procedure

1. The procedure begins with the patient being appropriately prepped and anesthetized or sedated in the catheterization lab.
2. The provider then punctures the skin over the femoral vein and inserts a needle to introduce a guidewire.
3. Under imaging guidance, the provider guides a steerable catheter over the guidewire through the femoral vein, up through the vena cava, and into the right ventricle.
4. The guidewire is removed, and the provider passes a leadless pacemaker through the catheter and fixes it on the endocardium using the helix or tines at the end of the cylinder.
5. After the pacemaker is delivered, the provider slowly removes the catheter and applies pressure over the site to control bleeding.
6. The provider may then interrogate the pacemaker’s function and adjust the programming parameters as needed.

4. Qualifying circumstances

CPT 33274 is performed on patients who require the insertion or replacement of a permanent leadless pacemaker in the right ventricle. The procedure is typically done in the catheterization lab and requires imaging guidance, such as fluoroscopy, venous ultrasound, ventriculography, and femoral venography. The pacemaker is inserted via a catheter inserted through the femoral vein. The patient must meet the medical necessity criteria for this procedure, which is determined by the provider.

5. When to use CPT code 33274

CPT code 33274 should be used when a provider performs the transcatheter insertion or replacement of a permanent leadless pacemaker in the right ventricle. This code includes imaging guidance and device evaluation or programming when performed. It is important to note that this code cannot be reported separately for the imaging guidance or device evaluation, as they are bundled into the code.

6. Documentation requirements

To support a claim for CPT 33274, the provider must document the following information:

• Indication for the procedure
• Details of the procedure, including the use of imaging guidance and any complications encountered
• Type and model of the leadless pacemaker inserted or replaced
• Device evaluation or programming performed, if applicable
• Start and end time of the procedure
• Any additional relevant information, such as patient positioning or anesthesia used

7. Billing guidelines

When billing for CPT 33274, ensure that the procedure meets the criteria for medical necessity and is performed by a qualified provider. The code includes imaging guidance and device evaluation or programming when performed, so these services should not be reported separately. It is important to check with Medicare or other payers to determine their coverage policies for leadless pacemakers, as some may consider them investigational and may not provide coverage.

8. Historical information

CPT 33274 was added to the Current Procedural Terminology system on January 1, 2019. There have been no updates to the code since its addition.

9. Examples

1. A patient undergoes the transcatheter insertion of a permanent leadless pacemaker in the right ventricle. The procedure is performed under imaging guidance, and the provider also performs device evaluation and programming.
2. A leadless pacemaker in the right ventricle needs to be replaced, and the provider performs the transcatheter replacement procedure using imaging guidance.
3. A patient with a malfunctioning leadless pacemaker in the right ventricle requires the device to be repositioned. The provider performs the transcatheter repositioning procedure, ensuring proper placement under imaging guidance.
4. A patient with a previously inserted leadless pacemaker in the right ventricle requires device evaluation and programming. The provider performs the necessary procedures to assess the pacemaker’s function and adjust the programming parameters.
5. A leadless pacemaker in the right ventricle needs to be removed due to infection. The provider performs the transcatheter removal procedure, ensuring proper removal under imaging guidance.