EmailAICD / Pacemaker Insertions
Publication Date: September 2005
ICD 10 AM Edition: Fourth edition
Retired Date: 30/6/2010
Query Number: 2162
Doctors at our hospital have advised that all AICD units have both pacemaker and defibrillator functionality. One lead from the AICD unit performs both functions (pacing and defibrillating). This lead is placed into the right ventricle.
Depending on the pacemaker function required depends on the number of leads to be inserted.
The problem that coders face is how should we capture the fact that one of the leads doubles up to act as a defibrillator lead as well as a pace maker lead? If we code each one out, it appears that an extra lead has been inserted when it hasn't.
A Biventricular AICD unit requires a lead to pace the atrium and a lead to both ventricles.
38524-00 Insertion of automatic defibrillator generator
38521-03 Insertion of defibrillation electrodes (leads) for automatic defibrillator (1 electrode)
38281-13 Insertion of permanent triple chamber pacemaker
90214-00 Insertion of permanent triple chamber transvenous electrodes (3 electrodes)
Looking at these codes it would appear that 4 wires have been inserted but in reality only 3 wires have been inserted. To code 2 pacing electrodes with a triple chamber pacemaker would not appear correct.
The same occurs with an AICD (VVI 40). This is a unit with one lead to the right ventricle. It both has a pacing threshold of 40 beats per minute (indicated by VVI 40) and a defibrillator coil.
To code the pacemaker VVI without an electrode would not follow the ‘includes note’ in the procedure code.
Therefore we have been coding:
38524-00 Insertion of automatic defibrillator generator
38521-03 Insertion of defibrillation electrodes (leads) for automatic defibrillator (1 electrode)
38281-02 Insertion of permanent single chamber pacemaker, VV
38278-01 Insertion of permanent transvenous electrode into ventricle (1 electrode)
Again this creates a picture that 2 electrodes have been inserted when in fact only one has been inserted.
Can the VCC please advise if we are interpreting the errata and 'code also' notes correctly? If not, please advise how we should be coding these cases.
Search Details:
Discussion with Cardiologists at Box Hill Hospital.
Review of NCCH Query 2072.
Vol 3 errata under blocks 650 - 653.
Depending on the pacemaker function required depends on the number of leads to be inserted.
The problem that coders face is how should we capture the fact that one of the leads doubles up to act as a defibrillator lead as well as a pace maker lead? If we code each one out, it appears that an extra lead has been inserted when it hasn't.
A Biventricular AICD unit requires a lead to pace the atrium and a lead to both ventricles.
38524-00 Insertion of automatic defibrillator generator
38521-03 Insertion of defibrillation electrodes (leads) for automatic defibrillator (1 electrode)
38281-13 Insertion of permanent triple chamber pacemaker
90214-00 Insertion of permanent triple chamber transvenous electrodes (3 electrodes)
Looking at these codes it would appear that 4 wires have been inserted but in reality only 3 wires have been inserted. To code 2 pacing electrodes with a triple chamber pacemaker would not appear correct.
The same occurs with an AICD (VVI 40). This is a unit with one lead to the right ventricle. It both has a pacing threshold of 40 beats per minute (indicated by VVI 40) and a defibrillator coil.
To code the pacemaker VVI without an electrode would not follow the ‘includes note’ in the procedure code.
Therefore we have been coding:
38524-00 Insertion of automatic defibrillator generator
38521-03 Insertion of defibrillation electrodes (leads) for automatic defibrillator (1 electrode)
38281-02 Insertion of permanent single chamber pacemaker, VV
38278-01 Insertion of permanent transvenous electrode into ventricle (1 electrode)
Again this creates a picture that 2 electrodes have been inserted when in fact only one has been inserted.
Can the VCC please advise if we are interpreting the errata and 'code also' notes correctly? If not, please advise how we should be coding these cases.
Search Details:
Discussion with Cardiologists at Box Hill Hospital.
Review of NCCH Query 2072.
Vol 3 errata under blocks 650 - 653.
Response
The Victorian ICD Coding Committee recognises the difficulties in assigning codes for these procedures and will prepare a public submission for NCCH requesting a review of AICD and pacemaker codes and coding standards. Until these codes can be reviewed and updated appropriately, assign a code for each component performed knowing that the end result will not precisely match the actual procedure performed. The codes that you have provided in your query are appropriate.
