ICD-10-CM PDx: I44.2 (Atriventricular block, complete)
ICD-9-CM PDx: 426.0
0JH636Z (Insertion of pacemaker, dual chamber into chest subcutaneous tissue and fascia, percutaneous approach)
02H63JZ (Insertion of pacemaker lead into right atrium, percutaneous approach)
02HK3JZ (Insertion of pacemaker lead into right ventricle, percutaneous approach)
3E0132A (Introduction of anti-infective envelope into subcutaneous tissue, percutaneous approach)
- At least two codes are required for the initial insertion of a permanent pacemaker; one code for the pulse generator and one code for the leads. The pulse generator is a small device that is implanted under the skin, just below the collarbone. The leads are thin, soft insulated wires placed in the right atrium/ventricle.
- How a pacemaker works: The pacemaker leads (electrodes) detect the heart’s OWN electrical activity and transmit that information to the pulse generator (computer.) The computer analyzes the heart’s signals and decides when and where to pace. If the rate is slow, the generator emits a signal to stimulate contraction and increase the rate.
- Approach: Since the approach, percutaneous, was assigned in all 4 coding answers, let’s review. According to PCS guideline B5.4: Procedures performed percutaneously via a device placed for the procedure are coded to the approach Percutaneous: entry by puncture or minor incision or instrumentation through the skin and mucous membrane and/or any other body layers necessary to reach the site of the procedure. The devices including the pulse generator, the two leads, and the antimicrobial envelope, were all placed percutaneously. The approach for the leads was percutaneous (transvenous,) which codes to the approach percutaneous.
- Single/dual chamber: For single chamber pacing, either the right atrium (upper chamber) or the right ventricle (lower chamber) is paced. Only one pacing lead is used. For dual chamber pacing, both the right atrium and right ventricle are paced. This requires two pacing leads. One lead is placed in the right atrium, and the other lead is placed in the right ventricle.
- I44.2: Block > heart > third degree (atrioventricular)
- 0JH636Z: Px index > Pacemaker > Dual Chamber > Chest > 0JH6 > lcate table 0JH and go across the row to assign the remaining characters:
Insertion is defined as “Putting in a nonbiological appliance that monitors, assists, performs or prevents a physiological function but does not take the place of a body part.”
- 02H63JZ: Px index > Insertion of device in > Atrium > Right > 02H6 > locate table 02H and go across the row to assign the remaining characters:
- 02HK3JZ: Px index > Insertion of device in > Ventricle > Right > 02HK > locate table 02HK and go across the row to assign the remaining characters:
- 3E0102A: Px index > Introduction of substance in or on > Subcutaneous Tissue > Anti-infective > 3E01 > go to table 3E0 and after you locate the correct row, go across it to assign the remaining characters:
Introduction is defined in ICD-10-PCS as “Putting in or on a therapeutic, diagnostic, nutritional, physiological, or prophylactic substance except blood or blood products. An antibacterial envelope is a mesh pouch or envelope that carries or holds the implanted pacemaker. The envelope creates a stable environment surrounding the device and leads after surgical placement and the biocompatible mesh is coated with antibiotics that elute (dissolve) within a 7 to 10 day period.
- 1.ICD-10-CM-PCS Official Coding Guidelines, 2013, p. 12
- Davy Ellen Chabner, The Language of Medicine, 2011, p. 413