Removal of transvenous pacemaker electrodes for a single lead system, whether atrial or ventricular is reported with code 33234 however, if it is a duel lead system the accurate code to report would be 33235.

Repositioning is one of the easier procedures to correctly code, there are only two codes used for repositioning. 33215 is used if the documentation supports right atrial or right ventricular, if the documentation supports left ventricular the coder would apply code 33226, the complicated part is that a coder must know that when coding 33226 this includes not only repositioning but also the removal, insertion and/or replacement of the battery.

Pacemaker coding is very detailed as there are very different rules for each aspect from insertion, removal, repair, repositioning and even battery replacement. Other important factors to consider which will affect the codes reported for each procedure is whether the pacemaker is temporary or permanent as well as if it is a single, dual or multiple electrode (leads) pacemaker.

If a permanent pacemaker is inserted or replaced a coder would report code 33206, if that pacemaker is atrial, if it is ventricular, code 33207 is used however, some pacemakers are both atrial and ventricular and code 33208 would be the correct code to bill, it is imperative to know and code the difference as this plays a major role in the doctor’s reimbursement.

Complications related to implantation occur in only a few cases, and are typically those inherent in catheterization, such as bleeding, a punctured vein, infection, or a collapsed lung. Patients usually remain in the hospital for two or three days of evaluation to ensure that the pacemaker is working properly. Most people can resume a full schedule and return to work or school after two weeks.

All patients with pacemakers should have regular follow-up visits with their doctors to verify that the device is performing optimally. The increasing complexity of programmable pacemakers requires physicians to keep thorough and accurate records of the patient’s pacemaker settings so that consistent follow-up is assured should the patient come under the care of a different doctor. Simple devices are available that allow the physician to test the function of the pacemaker battery. The lithium batteries typically last eight to ten years and can be replaced by reopening the pacemaker pouch under local anesthesia. This is a relatively minor surgical procedure that does not require hospitalization (Batsford, 1992, p. 333).

Another very common procedure for the invasive cardiologist is the implantation of a pacemaker. Pacemaker implantation is a surgical procedure that is performed under local anesthesia and requires only a brief hospitalization.

First, a catheter is inserted into the chest, usually through the subclavian vein, which is located below the collarbone and above the heart. The pacemaker’s leads are then threaded through the catheter to the appropriate chamber or chambers of the heart. The electrodes are maneuvered into contact with the inner surface of the atrium or ventricle. Finally the surgeon makes a small “pocket” in the pad of flesh (under the skin) on the upper portion of the chest wall to hold the power source. This pocket is then closed with stitches, Ieaving a small scar. The battery can usually be felt easily through the skin.

As with any other procedure, this particular procedure has its own reporting code, 93543 is used for the injection portion of the test while 93555-26 is used for the imaging portion. It is important not to confuse this with imaging code 93556 as used with the coronary artery.

The coronary, left internal mammary, left ventriculography, and pulmonary artery grafts are all common procedures performed during the heart catheterization.

In conclusion of the heart catheterization and as an example, a very common and typical heart cath will show and be coded as follows:

LHC (left heart cath) 93510-26
COR (coronary angiograph) 93545 (injection)
93556-26 (imaging)
LVG (left ventriculography) 93543 (injection)
93555-26 (imaging)

The heart must also have its own access to the blood supply in order to keep pumping blood to the rest of the body. Two coronary arteries supply the heart with blood. They are the first branches of the aorta and rise just above the aortic valve. The main vessels carrying blood run upon the surface of the heart and penetrate into the muscle. Because a consistent supply of oxygen is so essential, there are a large number of myocardial capillaries which keep blood flowing to the heart. The ratio between muscle cells and capillaries is 1:1. Several veins, including the coronary sinus, which runs from the posterior AV groove to the right atrium, gather coronary venous blood and collect it.

All tissues and organs in the body are made up of cells and the heart is no different. It contains many highly specialized cells that allow it to function properly. There are many similarities shared by all cardiac cells. Each type contains a nucleus, mitochondria, myofibrils, and sarcoplasmic reticulum. Each cell also has differences in form and function that set it apart from other cardiac cells. P cells are ovoid cells found in the sinus and AV nodes.They have less myofibrils, mitochondria, and glycogen than other cells found in the heart. They make infrequent contact with other cells. They excite themselves and those in the sinus node are in charge of initiating each heartbeat and transitional cells are an intermediate between P cells and myocardial cells.

Before the test, the subject is given medicine to help them relax and will be awake and able to follow instructions during the test.

An intravenous line is placed in the arm; the health care provider cleans and numbs an area on the arm or groin. A cardiologist makes a small cut in the area and inserts a thin flexible tube (catheter) into an artery. Using x-rays as a guide, the doctor carefully moves the catheter into your heart, when the tube is in place dye is injected through it, the dye flows through the blood vessels making them easier to see. X-rays are taken as the dye moves through the blood vessels; these x-ray pictures create a “movie” of the left ventricle as it contracts rhythmically. The procedure may last from 1 to several hours (Mikati, 2010).

Correct coding for the LIMA is 93540, if the pulmonary artery is accessed then code 93541 would be used instead, as with the coronary artery code 93545, these codes are for the injection portion of the procedure only; the imaging code 93556 with modifier 26 is also coded and reported.

Another very common procedure performed during the heart cath is a left heart ventricular angiography (also called left ventriculography); this is a procedure that is done to look at the left side of the heart and, sometimes, the coronary arteries.

“For a while now, so-called ‘medical billing opportunities’ have been rising in popularity as a work-from-home easy way to earn an income. Because of rampant misrepresentation of earnings, these opportunities over looked for some time as being scams and the like.

Nowadays, most of the popular billing opportunities are great resources for practical knowledge in owning and operating your own medical billing company. As you may know, cardiology billing has one of the highest ROI and profitability margins of most practices. Because these practices are high sales volume, many independent medical billing professionals are taking education from these opportunities or franchises and making a nice living off of specialized cardiology billing.

For those people living in highly populated areas, you may find that competition in the field is extremely tight and it is very hard to make money with the overabundance of competition. Consider your location wisely before making any long term investment plans or before you shell out large amounts of money on a medical billing opportunity. In many cases, however, the managers of the opportunities will have helpful demographic statistics on profitable areas to start your firm.”

This quote was taken from Adam Nager of Quest National Services, who among helping entrepreneurs with start-up medical billing firms across the nation, also offers specialized cardiology medical billing services as part of their business model.

The heart is a delicate piece of machinery that carefully balances many functions in order to carry out the basic necessities of sustaining life. First and foremost, the heart functions as a pump. To do this effectively, its chambers must be excited not only rhythmically, but also in the proper sequence. Ventricular cells must also contract synchronously to generate the expulsive force necessary to pump blood efficiently. Specialized tissues within the heart initiate and conduct the rhythmic depolarization that triggers contractions of the myocardial cells. The major tissues involved in this process are the AV node, the AV bundle, the intermodal tracts, and the sinus node. The AV node can be found under the endocardium of the right atrium above the insertion of the tricuspid valve. It contains many pacemaker cells and transitional cells embedded in collagen. The AV bundle is approximately 1-2 cm long and divides into two parts or bundle branches. The left passes down the interventricular septum in the direction of the apex. It lies under the endocardium of the left ventricle and separates into two divisions. The anterosuperior division runs down toward the anterior papillary muscle and activates the anterior and anterolateral portions of the ventricle. The posteroinferior division runs through toward the posterior papillary muscle and it activates the posterior and posterolateral regions of the ventricle. The right bundle branch goes down the right side of the interventricular septum and supplies all of the parts of the right ventricle.The sinus node, which is approximately 1-2 cm in length is located underneath the epicardium where the superior vena cava crosses the right atrium. It also contains many pacemaker and transitional cells in collagen.