Cardiac Resynchronization Therapy

10.2.2 - Cardiac Resynchronization Therapy (Rev. 2386, Issued: 01-13-12, Effective: 01-01-12, Implementation: 01-03-12) Effective for services furnished on or after January 1, 2012, cardiac resynchronization therapy involving an implantable cardioverter defibrillator (CRT-D) will be recognized as a single, composite service combining implantable cardioverter defibrillator procedures (described by CPT code 33249 (Insertion or repositioning of electrode lead(s) for single or dual chamber pacing cardioverter-defibrillator and insertion of pulse generator )) and pacing electrode insertion procedures (described by CPT code 33225 (Insertion of pacing electrode, cardiac venous system, for left ventricular pacing, at time of insertion of pacing cardioverter-defibrillator or pacemaker pulse generator (including upgrade to dual chamber system))) when performed on the same date of service. When these procedures appear on the same claim but with different dates of service, or appear on the claim without the other procedure, the standard APC assignment for each service will continue to be applied. Medicare will make a single payment for those procedures that qualify for composite service payment, as well as any packaged services furnished on the same date of service. Because CPT codes 33225 and 33249 may be treated as a composite service for payment purposes, CMS is assigning them status indicator “Q3” (Codes that may be paid through a composite APC) in Addendum B. Hospitals will continue to use the same CPT codes to report CRT-D procedures, and the I/OCE will evaluate every claim received to determine if payment as a composite service is appropriate. Specifically, the I/OCE will determine whether payment will be made through a single, composite payment when the procedures are done on the same date of service, or through the standard APC payment methodology when they are done on different dates of service. CMS is also implementing claims processing edits that will return to providers incorrectly coded claims on which a pacing electrode insertion procedure described by CPT code 33225 is billed without one of the following CPT codes for insertion of an implantable cardioverter defibrillator or pacemaker: • 33206 (Insertion or replacement of permanent pacemaker with transvenous electrode(s); atrial); • 33207 (Insertion or replacement of permanent pacemaker with transvenous electrode(s); ventricular); • 33208 (Insertion or replacement of permanent pacemaker with transvenous electrode(s); atrial and ventricular); • 33212 (Insertion or replacement of pacemaker pulse generator only; single chamber, atrial or ventricular); • 33213 (Insertion or replacement of pacemaker pulse generator only; dual chamber, atrial or ventricular); • 33214 (Upgrade of implanted pacemaker system, conversion of single chamber system to dual chamber system (includes removal of previously placed pulse generator, testing of existing lead, insertion of new lead, insertion of new pulse generator)); • 33216 (Insertion of a single transvenous electrode, permanent pacemaker or cardioverter-defibrillator); • 33217 (Insertion of 2 transvenous electrodes, permanent pacemaker or cardioverter-defibrillator); • 33221(Insertion of pacemaker pulse generator only; with existing multiple leads); • 33222 (Revision or relocation of skin pocket for pacemaker); • 33230 (Insertion of pacing cardioverter-defibrillator pulse generator only; with existing dual leads); • 33231 (Insertion of pacing cardioverter-defibrillator pulse generator only; with existing multiple leads) • 33233 (Removal of permanent pacemaker pulse generator); • 33234 (Removal of transvenous pacemaker electrode(s); single lead system, atrial or ventricular); • 33235 (Removal of transvenous pacemaker electrode(s); dual lead system, atrial or ventricular); • 33240 (Insertion of single or dual chamber pacing cardioverter-defibrillator pulse generator); or • 33249 (Insertion or repositioning of electrode lead(s) for single or dual chamber pacing cardioverter-defibrillator and insertion of pulse generator).