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The CPT® Code 33225 refers to the procedure involving the insertion of a pacing electrode into the cardiac venous system specifically for left ventricular pacing. This procedure is performed concurrently with the insertion of an implantable defibrillator or a pacemaker pulse generator. The pacing electrode is crucial for patients suffering from advanced heart failure, particularly those with a condition known as bundle branch block, which can lead to asynchronous contractions of the heart's ventricles. By placing the pacing electrode in the cardiac venous system, the physician aims to synchronize the contractions of the right and left ventricles, thereby improving overall heart function. This therapeutic approach is often categorized under cardiac resynchronization therapy (CRT) or biventricular pacing. The procedure not only involves the placement of the pacing electrode but also the attachment of this electrode to a pacemaker or implantable defibrillator, which is essential for delivering the necessary electrical impulses to the heart. The insertion of the pacing electrode is considered an additional procedure and is billed separately from the primary procedure of implanting the defibrillator or pacemaker generator.
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The procedure associated with CPT® Code 33225 is indicated for patients with advanced heart failure, particularly those exhibiting symptoms related to asynchronous ventricular contractions due to bundle branch block. The following conditions may warrant the insertion of a pacing electrode in the cardiac venous system for left ventricular pacing:
The procedure for CPT® Code 33225 involves several critical steps to ensure the successful insertion of the pacing electrode and the pacemaker or implantable defibrillator generator. The following procedural steps are outlined:
Post-procedure care for patients who have undergone the insertion of a pacing electrode under CPT® Code 33225 includes monitoring for any complications, such as infection or lead displacement. Patients are typically observed in a recovery area until they are stable. Follow-up appointments are essential to assess the function of the pacing system and to make any necessary adjustments. Patients may also receive instructions regarding activity restrictions and signs of potential complications to watch for as they recover. It is important for healthcare providers to ensure that patients understand their post-procedure care plan to promote optimal recovery and device function.
| Short Descr | L VENTRIC PACING LEAD ADD-ON | Medium Descr | INSJ ELTRD CAR VEN SYS TM INSJ DFB/PM PLS GEN | Long Descr | 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) | Status Code | Active Code | Global Days | ZZZ - Code Related to Another Service | PC/TC Indicator (26, TC) | 0 - Physician Service Code | Multiple Procedures (51) | 0 - No 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 | Items and Services Packaged into APC Rates | ASC Payment Indicator | Packaged service/item; no separate payment made. | Type of Service (TOS) | 2 - Surgery | Berenson-Eggers TOS (BETOS) | P2B - Major procedure, cardiovascular-Aneurysm repair | MUE | 1 | CCS Clinical Classification | 48 - Insertion, revision, replacement, removal of cardiac pacemaker or cardioverter/defibrillator |
This is an add-on code that must be used in conjunction with one of these primary codes.
| 33206 | MPFS Status: Active Code APC J1 ASC J8 Physician Quality Reporting PUB 100 CPT Assistant Article Insertion of new or replacement of permanent pacemaker with transvenous electrode(s); atrial | 33207 | MPFS Status: Active Code APC J1 ASC J8 Physician Quality Reporting PUB 100 CPT Assistant Article Insertion of new or replacement of permanent pacemaker with transvenous electrode(s); ventricular | 33208 | MPFS Status: Active Code APC J1 ASC J8 Physician Quality Reporting PUB 100 CPT Assistant Article Insertion of new or replacement of permanent pacemaker with transvenous electrode(s); atrial and ventricular | 33212 | MPFS Status: Active Code APC J1 ASC J8 Physician Quality Reporting PUB 100 CPT Assistant Article Insertion of pacemaker pulse generator only; with existing single lead | 33213 | MPFS Status: Active Code APC J1 ASC J8 Physician Quality Reporting PUB 100 CPT Assistant Article Insertion of pacemaker pulse generator only; with existing dual leads | 33214 | MPFS Status: Active Code APC J1 ASC J8 Physician Quality Reporting PUB 100 CPT Assistant Article 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 | MPFS Status: Active Code APC J1 ASC J8 Physician Quality Reporting PUB 100 CPT Assistant Article Insertion of a single transvenous electrode, permanent pacemaker or implantable defibrillator | 33217 | MPFS Status: Active Code APC J1 ASC J8 Physician Quality Reporting PUB 100 CPT Assistant Article Insertion of 2 transvenous electrodes, permanent pacemaker or implantable defibrillator | 33221 | Resequenced Code MPFS Status: Active Code APC J1 ASC J8 Insertion of pacemaker pulse generator only; with existing multiple leads | 33222 | MPFS Status: Active Code APC T ASC A2 Physician Quality Reporting PUB 100 CPT Assistant Article Illustration for Code Relocation of skin pocket for pacemaker | 33223 | MPFS Status: Active Code APC T ASC A2 Physician Quality Reporting PUB 100 CPT Assistant Article Relocation of skin pocket for implantable defibrillator | 33228 | Resequenced Code MPFS Status: Active Code APC J1 ASC J8 Removal of permanent pacemaker pulse generator with replacement of pacemaker pulse generator; dual lead system | 33229 | Resequenced Code MPFS Status: Active Code APC J1 ASC J8 Removal of permanent pacemaker pulse generator with replacement of pacemaker pulse generator; multiple lead system | 33230 | Resequenced Code MPFS Status: Active Code APC J1 ASC J8 Insertion of implantable defibrillator pulse generator only; with existing dual leads | 33231 | Resequenced Code MPFS Status: Active Code APC J1 ASC J8 Insertion of implantable defibrillator pulse generator only; with existing multiple leads | 33233 | MPFS Status: Active Code APC Q2 ASC J8 Physician Quality Reporting PUB 100 CPT Assistant Article Illustration for Code Removal of permanent pacemaker pulse generator only | 33234 | MPFS Status: Active Code APC Q2 ASC G2 Physician Quality Reporting PUB 100 CPT Assistant Article Illustration for Code Removal of transvenous pacemaker electrode(s); single lead system, atrial or ventricular | 33235 | MPFS Status: Active Code APC Q2 ASC G2 Physician Quality Reporting PUB 100 CPT Assistant Article Illustration for Code Removal of transvenous pacemaker electrode(s); dual lead system | 33240 | MPFS Status: Active Code APC J1 ASC J8 Physician Quality Reporting PUB 100 CPT Assistant Article Illustration for Code Insertion of implantable defibrillator pulse generator only; with existing single lead | 33249 | MPFS Status: Active Code APC J1 ASC J8 Physician Quality Reporting PUB 100 CPT Assistant Article Illustration for Code Insertion or replacement of permanent implantable defibrillator system, with transvenous lead(s), single or dual chamber | 33263 | Resequenced Code MPFS Status: Active Code APC J1 ASC J8 Removal of implantable defibrillator pulse generator with replacement of implantable defibrillator pulse generator; dual lead system | 33264 | Resequenced Code MPFS Status: Active Code APC J1 ASC J8 Removal of implantable defibrillator pulse generator with replacement of implantable defibrillator pulse generator; multiple lead system |
| GC | This service has been performed in part by a resident under the direction of a teaching physician | KX | Requirements specified in the medical policy have been met | 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. | Q0 | Investigational clinical service provided in a clinical research study that is in an approved clinical research study | GZ | Item or service expected to be denied as not reasonable and necessary | 53 | Discontinued procedure: under certain circumstances, the physician or other qualified health care professional may elect to terminate a surgical or diagnostic procedure. due to extenuating circumstances or those that threaten the well being of the patient, it may be necessary to indicate that a surgical or diagnostic procedure was started but discontinued. this circumstance may be reported by adding modifier 53 to the code reported by the individual for the discontinued procedure. note: this modifier is not used to report the elective cancellation of a procedure prior to the patient's anesthesia induction and/or surgical preparation in the operating suite. for outpatient hospital/ambulatory surgery center (asc) 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). | AO | Alternate payment method declined by provider of service | AQ | Physician providing a service in an unlisted health professional shortage area (hpsa) | SC | Medically necessary service or supply | XU | Unusual non-overlapping service, the use of a service that is distinct because it does not overlap usual components of the main service | 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). | 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. | 74 | Discontinued out-patient hospital/ambulatory surgery center (asc) procedure after administration of anesthesia: due to extenuating circumstances or those that threaten the well being of the patient, the physician may terminate a surgical or diagnostic procedure after the administration of anesthesia (local, regional block(s), general) or after the procedure was started (incision made, intubation started, scope inserted, etc). under these circumstances, the procedure started but terminated can be reported by its usual procedure number and the addition of modifier 74. note: the elective cancellation of a service prior to the administration of anesthesia and/or surgical preparation of the patient should not be reported. for physician reporting of a discontinued procedure, see modifier 53. | 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.) | 80 | Assistant surgeon: surgical assistant services may be identified by adding modifier 80 to the usual procedure number(s). | AS | Physician assistant, nurse practitioner, or clinical nurse specialist services for assistant at surgery | CR | Catastrophe/disaster related | ET | Emergency services | FS | Split (or shared) evaluation and management visit | GA | Waiver of liability statement issued as required by payer policy, individual case | 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 | GY | Item or service statutorily excluded, does not meet the definition of any medicare benefit or, for non-medicare insurers, is not a contract benefit | LT | Left side (used to identify procedures performed on the left side of the body) | PD | Diagnostic or related non diagnostic item or service provided in a wholly owned or operated entity to a patient who is admitted as an inpatient within 3 days | Q1 | Routine clinical service provided in a clinical research study that is in an approved clinical research study | Q5 | Service furnished under a reciprocal billing arrangement by a substitute physician or by a substitute physical therapist furnishing outpatient physical therapy services in a health professional shortage area, a medically underserved area, or a rural area | Q6 | Service furnished under a fee-for-time compensation arrangement by a substitute physician or by a substitute physical therapist furnishing outpatient physical therapy services in a health professional shortage area, a medically underserved area, or a rural area | RT | Right side (used to identify procedures performed on the right side of the body) | TG | Complex/high tech level of care | X3 | Episodic/broad services: for reporting services by clinicians who have broad responsibility for the comprehensive needs of the patient that is limited to a defined period and circumstance such as a hospitalization; reporting clinician service examples include but are not limited to the hospitalist's services rendered providing comprehensive and general care to a patient while admitted to the hospital | 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 | XE | Separate encounter, a service that is distinct because it occurred during a separate encounter | XP | Separate practitioner, a service that is distinct because it was performed by a different practitioner | XS | Separate structure, a service that is distinct because it was performed on a separate organ/structure |
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| 2015-01-01 | Changed | Description Changed |
| 2013-01-01 | Changed | Description changed. Guideline information changed. |
| 2012-01-01 | Changed | Description Changed |
| 2003-01-01 | Added | First appearance in code book in 2003. |
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