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The procedure described by CPT® Code 33222 involves the relocation of the skin pocket for a pacemaker, which is a device implanted to help regulate heart rhythms. This procedure may be necessary when the existing skin pocket, where the pacemaker generator is housed, becomes problematic. Common issues that may necessitate this relocation include pain or discomfort at the current site, which can arise from various factors such as pressure on the skin, necrosis (tissue death), or erosion of the surrounding tissue. Additionally, complications like a hematoma, which is a localized collection of blood outside of blood vessels, or an infection can also prompt the need for this procedure. During the procedure, a surgical incision is made over the pacemaker generator, allowing access to the skin pocket. The generator is carefully removed, and the pocket is inspected for any complications. If a hematoma is identified, it is evacuated to prevent further issues. In cases of infection, the pocket may be flushed with an antibiotic solution to help manage the infection. The surrounding skin and subcutaneous tissue may also be debrided, which involves the removal of dead or infected tissue to promote healing. After addressing any complications, the old skin pocket is closed, and a new site is selected for the creation of a new skin pocket. The leads, which connect the pacemaker to the heart, are then reconnected to the pulse generator, and the system is tested to ensure proper functionality. Once confirmed, the generator is inserted into the newly fashioned pocket and secured to the underlying tissue before the new skin pocket is closed over it. This procedure is essential for maintaining the proper function of the pacemaker and ensuring patient comfort.
© Copyright 2025 Coding Ahead. All rights reserved.
The relocation of the skin pocket for a pacemaker, as described by CPT® Code 33222, is indicated in several specific scenarios. These include:
The procedure for relocating the skin pocket for a pacemaker involves several critical steps, each aimed at ensuring the safety and functionality of the device. The first step is to make an incision over the pacemaker or implantable defibrillator generator, providing access to the skin pocket. Once the incision is made, the skin pocket is opened, and the generator is carefully removed. This allows for a thorough inspection of the skin pocket to identify any complications that may be present. If a hematoma is detected during this inspection, it is evacuated to prevent further issues and promote healing. In cases where an infection is present, the skin pocket may be flushed with an antibiotic solution to help manage the infection effectively. Additionally, the surrounding skin and subcutaneous tissue may undergo debridement, which involves the removal of any dead or infected tissue to facilitate proper healing. After addressing these potential complications, the old skin pocket is closed to prepare for the next steps. A new site is then selected for the creation of a new skin pocket. This is a crucial step, as it ensures that the generator will be housed in a location that minimizes the risk of recurrence of the previous issues. Once the new skin pocket is fashioned, the leads that connect the pacemaker to the heart are reconnected to the pulse generator. The system is then tested to confirm that both the leads and the generator are functioning properly. After successful testing, the generator is inserted into the newly created pocket and sutured to the underlying tissue to secure it in place. Finally, the new skin pocket is closed over the generator, completing the procedure.
Post-procedure care following the relocation of the skin pocket for a pacemaker is essential for ensuring proper healing and minimizing complications. Patients are typically monitored for any signs of infection or complications at the new site. It is important to follow the physician's instructions regarding wound care, which may include keeping the area clean and dry, as well as changing dressings as directed. Patients may also be advised to avoid strenuous activities or heavy lifting for a specified period to allow for adequate healing. Follow-up appointments are crucial to assess the healing process and ensure that the pacemaker is functioning correctly in its new location. Any concerns or unusual symptoms should be reported to the healthcare provider promptly to address potential issues early.
| Short Descr | RELOCATION POCKET PACEMAKER | Medium Descr | RELOCATION OF SKIN POCKET FOR PACEMAKER | Long Descr | Relocation of skin pocket for pacemaker | 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 | Procedure or Service, Multiple Reduction Applies | ASC Payment Indicator | Surgical procedure on ASC list in CY 2007; payment based on OPPS relative payment weight. | 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) |
| 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). | 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. | XU | Unusual non-overlapping service, the use of a service that is distinct because it does not overlap usual components of the main service | XS | Separate structure, a service that is distinct because it was performed on a separate organ/structure | 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. | 24 | Unrelated evaluation and management service by the same physician or other qualified health care professional during a postoperative period: the physician or other qualified health care professional may need to indicate that an evaluation and management service was performed during a postoperative period for a reason(s) unrelated to the original procedure. this circumstance may be reported by adding modifier 24 to the appropriate level of e/m service. | 52 | Reduced services: under certain circumstances a service or procedure is partially reduced or eliminated at the discretion of the physician or other qualified health care professional. under these circumstances the service provided can be identified by its usual procedure number and the addition of modifier 52, signifying that the service is reduced. this provides a means of reporting reduced services without disturbing the identification of the basic service. note: for hospital outpatient reporting of a previously scheduled procedure/service that is partially reduced or cancelled as a result of extenuating circumstances or those that threaten the well-being of the patient prior to or after administration of anesthesia, see modifiers 73 and 74 (see modifiers approved for asc hospital outpatient use). | 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. | 76 | Repeat procedure or service by same physician or other qualified health care professional: it may be necessary to indicate that a procedure or service was repeated by the same physician or other qualified health care professional subsequent to the original procedure or service. this circumstance may be reported by adding modifier 76 to the repeated procedure or service. note: this modifier should not be appended to an e/m service. | 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.) | 79 | Unrelated procedure or service by the same physician or other qualified health care professional during the postoperative period: the individual may need to indicate that the performance of a procedure or service during the postoperative period was unrelated to the original procedure. this circumstance may be reported by using modifier 79. (for repeat procedures on the same day, see modifier 76.) | AO | Alternate payment method declined by provider of service | AQ | Physician providing a service in an unlisted health professional shortage area (hpsa) | AS | Physician assistant, nurse practitioner, or clinical nurse specialist services for assistant at surgery | CC | Procedure code change (use 'cc' when the procedure code submitted was changed either for administrative reasons or because an incorrect code was filed) | CR | Catastrophe/disaster related | 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 | GZ | Item or service expected to be denied as not reasonable and necessary | 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) | SG | Ambulatory surgical center (asc) facility service | XE | Separate encounter, a service that is distinct because it occurred during a separate encounter |
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| 2017-01-01 | Changed | Moderate (Conscious) Sedation flag removed. See new Moderate Sedation category. |
| 2014-01-01 | Changed | Description Changed |
| 2011-01-01 | Changed | Short description changed. |
| Pre-1990 | Added | Code added. |
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