How To Use CPT Code 93261

CPT 93261 describes the evaluation and analysis of an implantable subcutaneous lead defibrillator system by a physician or other qualified healthcare professional. This article will cover the description, procedure, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information, similar codes and billing examples.

1. What is CPT Code 93261?

CPT 93261 can be used to describe the evaluation and analysis of an implantable subcutaneous lead defibrillator system by a physician or other qualified healthcare professional. This code is used when the provider interacts directly with the patient to assess the functioning of the device and retrieve stored data about the lead, battery, and implanted pulse generator function. The provider then evaluates the data to determine the current programming of the device and reports the findings.

2. Official Description

The official description of CPT code 93261 is: ‘Interrogation device evaluation (in person) with analysis, review and report by a physician or other qualified health care professional, includes connection, recording and disconnection per patient encounter; implantable subcutaneous lead defibrillator system.’

3. Procedure

1. The provider interacts directly with the patient to evaluate the previously placed subcutaneous lead defibrillator system for proper functioning.
2. The provider retrieves the stored data about the lead, battery, and implanted pulse generator function.
3. The provider evaluates the retrieved data to determine the current programming of the device and also to evaluate certain aspects of the device function.
4. The provider may also connect, record, and disconnect the subcutaneous lead defibrillator system.
5. After analyzing all the data, the provider prepares a report of the findings.

4. Qualifying circumstances

Patients eligible to receive CPT 93261 services are those with an implantable subcutaneous lead defibrillator system. The provider must be a physician or other qualified healthcare professional. This code is not reported in conjunction with codes related to insertion, replacement, and repositioning of electrodes and pulse generator.

5. When to use CPT code 93261

CPT code 93261 should be used when a physician or other qualified healthcare professional performs an in-person evaluation and analysis of an implantable subcutaneous lead defibrillator system. This code should not be reported with codes related to insertion, replacement, and repositioning of electrodes and pulse generator.

6. Documentation requirements

To support a claim for CPT 93261, the provider must document the following information:

• Patient’s diagnosis and the need for evaluation and analysis of the implantable subcutaneous lead defibrillator system
• Specific details of the evaluation and analysis performed
• Date and duration of the encounter
• Report of the findings
• Signature of the physician or other qualified healthcare professional providing the service

7. Billing guidelines

When billing for CPT 93261, ensure that the provider performing the service is a physician or other qualified healthcare professional. This code should not be reported in conjunction with codes related to insertion, replacement, and repositioning of electrodes and pulse generator. Additional tips for reporting CPT 93261 may be available based on specific payer guidelines.

8. Historical information

CPT 93261 was added to the Current Procedural Terminology system on January 1, 2015. There have been no updates to the code since its addition.

9. Examples

1. A physician evaluating and analyzing the functioning of an implantable subcutaneous lead defibrillator system for a patient with a history of cardiac arrhythmias.
2. A qualified healthcare professional reviewing the stored data of an implantable subcutaneous lead defibrillator system to assess the programming and function of the device for a patient with a history of heart failure.
3. A physician connecting, recording, and analyzing the data from an implantable subcutaneous lead defibrillator system to determine the effectiveness of the device in a patient with a history of ventricular tachycardia.
4. A qualified healthcare professional evaluating and analyzing the functioning of an implantable subcutaneous lead defibrillator system for a patient with a history of sudden cardiac arrest.
5. A physician preparing a report of the findings after evaluating and analyzing the data from an implantable subcutaneous lead defibrillator system for a patient with a history of ventricular fibrillation.
6. A qualified healthcare professional reviewing the stored data of an implantable subcutaneous lead defibrillator system to assess the programming and function of the device for a patient with a history of atrial fibrillation.
7. A physician connecting, recording, and analyzing the data from an implantable subcutaneous lead defibrillator system to determine the effectiveness of the device in a patient with a history of bradycardia.
8. A qualified healthcare professional evaluating and analyzing the functioning of an implantable subcutaneous lead defibrillator system for a patient with a history of heart block.
9. A physician preparing a report of the findings after evaluating and analyzing the data from an implantable subcutaneous lead defibrillator system for a patient with a history of cardiac resynchronization therapy.