Author: Linda Kobayashi, BA, RHIT, CCS
Editor: Andrea Wong, BS, RHIT
For the past 2-3 weeks, we have addressed the cardiovascular system. Its impossible to cover everything and that has never been our intention. Keep in mind that we are painting with a broad brush.
What is a Pacemaker?
This week’s tidbit is on pacemakers. A pacemaker is a small device that’s placed in the chest or abdomen to help control abnormal heart rhythms. This device uses low-energy electrical pulses to prompt the heart to beat at a normal rate. Pacemakers are used to treat arrhythmias. Arrhythmias are problems with the rate or rhythm of the heartbeat (too slow, too fast, or irregular.)
Although it weighs just about an ounce, a pacemaker contains a powerful battery, electronic circuits, and computer memory that together generate electronic signals. The signals, or pacing pulses, are carried along thin, insulated wires, or leads, to the heart muscle. The signals cause the heart muscle to begin the contractions that cause a heartbeat. Simply stated, the pacemaker consists of two parts, the pacemaker itself or generator and the wires or leads.
Problem for this week: The patient, a 55-year-old woman, was seen by her doctor, complaining of shortness of breath, dizziness and fatigue. Her physician ordered a 12-lead EKG. After interpreting the results, she was diagnosed with bradycardia, a condition of the heart beating too slowly. This type of arrhythmia was complicated by tachycardia-bradycardia syndrome, aka sick sinus syndrome. She was admitted to the outpatient surgery setting for initial insertion of dual-chamber pacemaker, percutaneous approach, in the right atrium and the right ventricle. Code the diagnosis and ICD-10 procedures.
- I49.5 = Sick sinus syndrome
- 0JH636Z = Insertion of pacemaker, dual chamber into chest, subcutaneous tissue and fascia
- 02H63JZ = Insertion of pacemaker lead into right atrium, percutaneous approach
- 02HK3JZ = Insertion of pacemaker lead into right ventricle, percutaneous approach
To locate I49.5: Disease Index > Bradycardia > tachycardia syndrome > I49.5
- Difference between single versus dual chamber pacemaker: In a single chamber device, there is only one lead either to the atrium or the ventricle, whereas with a dual chamber pacemaker, there are two leads, one to the atrium and one to the ventricle.
- Sick sinus syndrome (SSS) and atrioventricular block (AV block) are the two most common reasons people have pacemakers implanted. Both involve the heart beating abnormally slowly.
- Pacemakers replace or control the heart’s own electrical activity.
To locate 0JH636Z: PCS Index > Pacemaker > Dual Chamber > Chest > 0JH6 > locate table 0JH and go across the row to finishing building the code after determining that the 4th character value of 6 is correct:
Insertion of Pacemaker, Dual Chamber, into Chest Subcutaneous Fascia, Percutaneous approach
- Root Operation: In our scenario, the root operation is Insertion.
- Insertion is defined as Putting in a nonbiological device that monitors, assists, performs or prevents a physiological function, but DOES NOT physically take the place of a body part.
- Please note that Single chamber pacemakers work on one of the chambers (sections) of the heart, while dual chamber pacemakers, which are more extensive, work on two simultaneously. The review of trials found that dual chamber pacemakers tended to prevent more subsequent heart problems than single chamber ventricular pacemakers.
- This procedure, 0JH636Z, accounts for creation and placement of the pocket, which will hold the generator in place. We still have to account for placement of the leads: We’ll start with lead placement in the atrium.
- Our scenario is for coding a permanent pacemaker, but catheters are often used for temporary pacemaker insertions. The use of a catheter or device to deliver treatment is not coded as insertion of a device because insertion is only coded when a device is left behind. Temporary pacemakers would be coded under the root operation, Performance.
To locate 02H63JZ: PCS Index > Insertion of device in > Atrium > Right > 02H6 > Locate table 02H and go across the row to finish building the code, making sure that the 4th character value of 6 is correct:
Insertion of Pacemaker into Right Atrium, Percutaneous Approach
- We aren’t finished yet, as we still have to account for the lead going to the left ventricle.
To locate 02HK3JZ: PCS Index > Insertion of device in > Ventricle > right > 02HK > locate table 02H and go across the row ensuring that the 4th character value of c 6 is correct:
Insertion of Pacemaker into Left Ventricle, Percutaneous Approach
- The 4th character value, for the body part, is the only difference between the 2 codes for lead placement in the heart. The other characters are the same.
- We do not code the diagnostic workup such as the EKG.
- Normally in the Outpatient surgery setting, a CPT code would be used to report the Insertion of the Pacemaker procedure, but not for this particular case.