CPT code 93279, 93280, 93281: Coding tips for Coders

Basics of CPT code 93279, 93280 & 93281

Medicare covers a variety of services for the post-implant follow-up and evaluation of implanted cardiac pacemakers. There are two general types of pacemakers in current use – single-chamber pacemakers which sense and pace the ventricles of the heart, and dual-chamber pacemakers which sense and pace both the atria and the ventricles. These differences require different monitoring patterns over the expected life of the units involved.

Many dual-chamber units may be programmed to pace only the ventricles; this may be done either at the time the pacemaker is implanted or at some time afterward. In such cases, a dual-chamber unit, when programmed or reprogrammed for ventricular pacing, should be treated as a single-chamber pacemaker in applying screening guidelines. Let us learn about CPT code 93279, 93280 & 93281 and when they should be used.

Effect of POA, CC, MCC and HAC in IP DRG coding

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Description of CPT code 93279, 93280 & 93281

A programming device evaluation is performed in person in order to test the device’s function and select the most favorable permanent programmed values. Patients with previously implanted pacemakers require periodic programming device evaluations. This diagnostic procedure includes a face-to-face assessment of all device functions. Components that must be evaluated in order to assign a code from this range include the battery, leads, capture and sensing function, heart rhythm, and programmed parameters.

Stored and measured data regarding these components are retrieved using an office, hospital, or emergency room instrument. This information is assessed to discern battery voltage, lead impedance, and settings for rhythm treatment and tachycardia detection, as well as to determine the pacemaker’s current programming. If necessary, the sensing value and rate response, upper and lower heart rates, AV intervals, pacing voltage and pulse duration, and diagnostics are adjusted.

These codes include physician or other qualified health care professional review, interpretation, and report, and are assigned per procedure. CPT code 93279 is reported for evaluation of a single-lead pacemaker or leadless system (one in which there is pacing and sensing function in only one chamber of the heart). CPT code 93280 is reported for evaluation of a dual-lead device (one with pacing and sensing function in only two chambers). CPT code 93281 is reported for evaluation of a multiple-lead device (one with pacing and sensing function in three or more chambers).

93279 Programming device evaluation (in person) with iterative adjustment of the implantable device to test the function of the device and select optimal permanent programmed values with analysis, review and report by a physician or other qualified health care professional; single lead pacemaker system or leadless pacemaker system in one cardiac chamber

93280 dual lead pacemaker system

93281 multiple lead pacemaker system

As per coding guidelines, the coders should not report 93279 in conjunction with 93286, 93288 and not report 93280 in conjunction with 93286, 93288.

Additional Code Information for CPT code 93279, 93280 & 93281

PC/TC Indicator (26): 1 = Diagnostic Tests for Radiology Services

Multiple Procedures (51): 6 = Subject to 25% reduction of the second highest and subsequent procedures to the TC of diagnostic cardiovascular services

Bilateral Surgery (50): 0 = 150% payment adjustment for bilateral procedures does not apply

Physician Supervision: 09 = Concept does not apply

Assistant Surgeon (80,82): 0 = Payment restriction for assistants at surgery applies to this procedure unless supporting documentation is submitted

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

HCPCS related to for CPT code 93279, 93280 & 93281

G0106 Colorectal cancer screening; alternative to G0104, screening sigmoidoscopy, barium enema
G0130 Single energy X-ray absorptiometry (SEXA) bone density study, one or more sites; appendicular skeleton (peripheral) (e.g., radius, wrist, heel)
G0248 Demonstration, prior to initiation of home INR monitoring, for patient with either mechanical heart valve(s), chronic atrial fibrillation, or venous thromboembolism who meets Medicare coverage criteria, under the direction of a physician; includes: face-to-face demonstration of use and care of the INR monitor, obtaining at least one blood sample, provision of instructions for reporting home INR test results, and documentation of patient’s ability to perform testing and report results
G0249 Provision of test materials and equipment for home INR monitoring of patient with either mechanical heart valve(s), chronic atrial fibrillation, or venous thromboembolism who meets Medicare coverage criteria; includes: provision of materials for use in the home and reporting of test results to physician; testing not occurring more frequently than once a week; testing materials, billing units of service include 4 tests
G0279 Diagnostic digital breast tomosynthesis, unilateral or bilateral (list separately in addition to 77065 or 77066)
G0398 Home sleep study test (HST) with type II portable monitor, unattended; minimum of 7 channels: EEG, EOG, EMG, ECG/heart rate, airflow, respiratory effort and oxygen saturation
G0399 Home sleep test (HST) with type III portable monitor, unattended; minimum of 4 channels: 2 respiratory movement/airflow, 1 ECG/heart rate and 1 oxygen saturation
G0400 Home sleep test (HST) with type IV portable monitor, unattended; minimum of 3 channels
G2066 Interrogation device evaluation(s), (remote) up to 30 days; implantable cardiovascular physiologic monitor system, implantable loop recorder system, or subcutaneous cardiac rhythm monitor system, remote data acquisition(s), receipt of transmissions and technician review, technical support and distribution of results
Q0035 Cardiokymography