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The procedure described by CPT® Code 33221 involves the insertion of a permanent cardiac pacemaker pulse generator that is connected to multiple existing leads. A cardiac pacemaker is a medical device that delivers electrical impulses to the heart, helping it maintain a normal rhythm, particularly in patients with arrhythmias or other heart rhythm disorders. The pulse generator is a crucial component of the pacemaker system, which can consist of one or more leads. These leads are responsible for transmitting the electrical impulses from the generator to the heart muscle. In this specific procedure, the focus is on the insertion of the pulse generator only, as the leads are already in place. The leads may be positioned either on the surface of the heart (epicardial) or within the heart chambers (endocardial), depending on the patient's specific needs and previous interventions. The insertion typically involves making an incision in the skin, usually located in the left pectoral region, where a subcutaneous pocket is created to house the pulse generator. After connecting the leads to the generator and ensuring proper functionality through testing, the generator is secured in the pocket, and the incision is closed. This procedure is essential for patients requiring ongoing cardiac pacing to ensure their heart functions effectively.
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The insertion of a pacemaker pulse generator, as described by CPT® Code 33221, is indicated for patients who require cardiac pacing due to various heart rhythm disorders. The following conditions may warrant this procedure:
The procedure for the insertion of a pacemaker pulse generator involves several critical steps to ensure proper placement and functionality of the device.
After the insertion of the pacemaker pulse generator, patients are typically monitored for any immediate complications. Post-procedure care may include instructions on activity restrictions, wound care, and signs of potential complications such as infection or lead displacement. Patients may also require follow-up appointments to assess the functionality of the pacemaker and make any necessary adjustments. Recovery time can vary, but most patients are advised to avoid strenuous activities for a period to allow for proper healing of the incision site.
| Short Descr | INSERT PULSE GEN MULT LEADS | Medium Descr | INS PACEMAKER PULSE GEN ONLY W/EXIST MULT LEADS | Long Descr | Insertion of pacemaker pulse generator only; with existing multiple leads | Status Code | Active Code | Global Days | 090 - Major Surgery | PC/TC Indicator (26, TC) | 0 - Physician Service Code | Multiple Procedures (51) | 2 - Standard payment adjustment rules for multiple procedures apply. | Bilateral Surgery (50) | 0 - 150% payment adjustment for bilateral procedures does NOT apply. | Physician Supervisions | 09 - Concept does not apply. | Assistant Surgeon (80, 82) | 1 - Statutory payment restriction for assistants at surgery applies to this procedure... | Co-Surgeons (62) | 0 - Co-surgeons not permitted for this procedure. | Team Surgery (66) | 0 - Team surgeons not permitted for this procedure. | Diagnostic Imaging Family | 99 - Concept Does Not Apply | APC Status Indicator | Hospital Part B services paid through a comprehensive APC | ASC Payment Indicator | Device-intensive procedure added to ASC list in CY 2008 or later; paid at adjusted rate. | Type of Service (TOS) | 2 - Surgery | Berenson-Eggers TOS (BETOS) | P2E - Major procedure, cardiovascular-Pacemaker insertion | MUE | 1 | CCS Clinical Classification | 48 - Insertion, revision, replacement, removal of cardiac pacemaker or cardioverter/defibrillator |
This is a primary code that can be used with these additional add-on codes.
| 33225 | Addon Code MPFS Status: Active Code APC N ASC N1 Physician Quality Reporting PUB 100 CPT Assistant Article Insertion of pacing electrode, cardiac venous system, for left ventricular pacing, at time of insertion of implantable defibrillator or pacemaker pulse generator (eg, for upgrade to dual chamber system) (List separately in addition to code for primary procedure) |
| 22 | Increased procedural services: when the work required to provide a service is substantially greater than typically required, it may be identified by adding modifier 22 to the usual procedure code. documentation must support the substantial additional work and the reason for the additional work (ie, increased intensity, time, technical difficulty of procedure, severity of patient's condition, physical and mental effort required). note: this modifier should not be appended to an e/m service. | 51 | Multiple procedures: when multiple procedures, other than e/m services, physical medicine and rehabilitation services or provision of supplies (eg, vaccines), are performed at the same session by the same individual, the primary procedure or service may be reported as listed. the additional procedure(s) or service(s) may be identified by appending modifier 51 to the additional procedure or service code(s). note: this modifier should not be appended to designated "add-on" codes (see appendix d). | 58 | Staged or related procedure or service by the same physician or other qualified health care professional during the postoperative period: it may be necessary to indicate that the performance of a procedure or service during the postoperative period was: (a) planned or anticipated (staged); (b) more extensive than the original procedure; or (c) for therapy following a surgical procedure. this circumstance may be reported by adding modifier 58 to the staged or related procedure. note: for treatment of a problem that requires a return to the operating/procedure room (eg, unanticipated clinical condition), see modifier 78. | 59 | Distinct procedural service: under certain circumstances, it may be necessary to indicate that a procedure or service was distinct or independent from other non-e/m services performed on the same day. modifier 59 is used to identify procedures/services, other than e/m services, that are not normally reported together, but are appropriate under the circumstances. documentation must support a different session, different procedure or surgery, different site or organ system, separate incision/excision, separate lesion, or separate injury (or area of injury in extensive injuries) not ordinarily encountered or performed on the same day by the same individual. however, when another already established modifier is appropriate it should be used rather than modifier 59. only if no more descriptive modifier is available, and the use of modifier 59 best explains the circumstances, should modifier 59 be used. note: modifier 59 should not be appended to an e/m service. to report a separate and distinct e/m service with a non-e/m service performed on the same date, see modifier 25. | 78 | Unplanned return to the operating/procedure room by the same physician or other qualified health care professional following initial procedure for a related procedure during the postoperative period: it may be necessary to indicate that another procedure was performed during the postoperative period of the initial procedure (unplanned procedure following initial procedure). when this procedure is related to the first, and requires the use of an operating/procedure room, it may be reported by adding modifier 78 to the related procedure. (for repeat procedures, see modifier 76.) | AO | Alternate payment method declined by provider of service | AS | Physician assistant, nurse practitioner, or clinical nurse specialist services for assistant at surgery | GC | This service has been performed in part by a resident under the direction of a teaching physician | GV | Attending physician not employed or paid under arrangement by the patient's hospice provider | GW | Service not related to the hospice patient's terminal condition | KX | Requirements specified in the medical policy have been met | LT | Left side (used to identify procedures performed on the left side of the body) | RT | Right side (used to identify procedures performed on the right side of the body) | SC | Medically necessary service or supply | X4 | Episodic/focused services: for reporting services by clinicians who provide focused care on particular types of treatment limited to a defined period and circumstance; the patient has a problem, acute or chronic, that will be treated with surgery, radiation, or some other type of generally time-limited intervention; reporting clinician service examples include but are not limited to, the orthopedic surgeon performing a knee replacement and seeing the patient through the postoperative period | XU | Unusual non-overlapping service, the use of a service that is distinct because it does not overlap usual components of the main service |
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| 2017-01-01 | Changed | Moderate (Conscious) Sedation flag removed. See new Moderate Sedation category. |
| 2012-01-01 | Added | Added |
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