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Official Description

Transcatheter removal of permanent leadless pacemaker, right ventricular, including imaging guidance (eg, fluoroscopy, venous ultrasound, ventriculography, femoral venography), when performed

© Copyright 2025 American Medical Association. All rights reserved.

Common Language Description

The CPT® Code 33275 refers to the transcatheter removal of a permanent leadless pacemaker from the right ventricle, which is a specialized procedure performed under imaging guidance. Leadless pacemakers are compact devices that consist of a pulse generator, a built-in battery, and an electrode, designed to regulate heart rhythms without the need for traditional leads. This procedure is typically indicated when there is a need to remove a previously implanted leadless pacemaker, which may be necessary due to complications, device malfunction, or patient-specific factors. The removal process involves accessing the femoral vein, utilizing imaging techniques such as fluoroscopy, venous ultrasound, ventriculography, or femoral venography to guide the retrieval of the device. The procedure is performed with precision to ensure the safety and effectiveness of the removal, minimizing risks associated with the intervention. Understanding the technical aspects and indications for this procedure is essential for medical coders and healthcare professionals involved in the billing and documentation processes related to cardiac device management.

© Copyright 2025 Coding Ahead. All rights reserved.

1. Indications

The transcatheter removal of a permanent leadless pacemaker, as described by CPT® Code 33275, is indicated in specific clinical scenarios. These may include:

  • Device Malfunction The leadless pacemaker may need to be removed if it is not functioning correctly, which could lead to inadequate heart rhythm management.
  • Complications Patients may experience complications related to the leadless pacemaker, necessitating its removal to prevent further health issues.
  • Patient-Specific Factors Changes in a patient's condition or health status may warrant the removal of the device, such as the need for a different pacing strategy or device type.

2. Procedure

The procedure for the transcatheter removal of a permanent leadless pacemaker involves several critical steps, which are detailed as follows:

  • Step 1: Preparation The procedure begins with the preparation and draping of the groin area to maintain a sterile environment. This is essential to reduce the risk of infection during the procedure.
  • Step 2: Accessing the Femoral Vein A percutaneous needle is used to access the femoral vein. This step is crucial as it provides the entry point for the venous sheath that will be used throughout the procedure.
  • Step 3: Insertion of the Venous Sheath A venous sheath is inserted through the needle into the femoral vein and advanced toward the right ventricle. This sheath serves as a conduit for the retrieval catheter.
  • Step 4: Imaging Guidance Throughout the procedure, imaging guidance is employed, which may include fluoroscopy, venous ultrasound, ventriculography, or femoral venography. This guidance is vital for accurately navigating to the leadless pacemaker's location within the right ventricle.
  • Step 5: Threading the Retrieval Catheter A retrieval catheter is carefully threaded through the sheath and into the right ventricle. This catheter is specifically designed to facilitate the removal of the leadless pacemaker.
  • Step 6: Locating and Detaching the Pacemaker Once the retrieval catheter is in place, the leadless pacemaker is located and detached from the myocardium. This step requires precision to ensure that the device is removed without damaging surrounding cardiac tissue.
  • Step 7: Removal of the Pacemaker The detached leadless pacemaker is then removed using the retrieval catheter. This step concludes the primary objective of the procedure.
  • Step 8: Withdrawal of the Venous Sheath After the pacemaker has been successfully removed, the venous sheath is withdrawn from the femoral vein, completing the procedure.

3. Post-Procedure

Following the transcatheter removal of a permanent leadless pacemaker, appropriate post-procedure care is essential. Patients are typically monitored for any immediate complications, such as bleeding or infection at the access site. Recovery may involve observation in a clinical setting to ensure that the patient is stable and that there are no adverse effects from the procedure. Instructions regarding activity restrictions and follow-up appointments may be provided to the patient to ensure proper healing and management of their cardiac health.

Short Descr TCAT RMVL PERM LDLS PM W/IMG
Medium Descr TCAT REMOVAL PERM LEADLESS PM RIGHT VENTR W/IMG
Long Descr Transcatheter removal of permanent leadless pacemaker, right ventricular, including imaging guidance (eg, fluoroscopy, venous ultrasound, ventriculography, femoral venography), when performed
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) none
MUE 1

This is a primary code that can be used with these additional add-on codes.

93662 Addon Code MPFS Status: Carrier Priced APC N PUB 100 CPT Assistant Article Intracardiac echocardiography during therapeutic/diagnostic intervention, including imaging supervision and interpretation (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).
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).
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.)
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.)
AQ Physician providing a service in an unlisted health professional shortage area (hpsa)
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
Q0 Investigational clinical service provided in a clinical research study that is in an approved clinical research study
XU Unusual non-overlapping service, the use of a service that is distinct because it does not overlap usual components of the main service
Date
Action
Notes
2024-01-01 Changed Guideline information changed.
2020-01-01 Changed Code description changed.
2019-01-01 Added Added
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