Insertion of passmaker cpt code modifier7/27/2023 ![]() ![]() ![]() This would be very rare, but I did want to cover the coding of this scenario in case you see it in your coding. You could also report 3326 with modifier 59 (or modifier XE) if for some reason the old monitor was removed during one encounter and the new monitor was inserted at a separate encounter later on the same day.As an example, you may see this in patients who have an infection in the location where the original monitor was inserted with a need to move the new device to a completely different location away from the infection. If, however, the old subcutaneous rhythm monitor is removed and a new device is placed through a separate incision you can report 3326 with modifier 59 (or modifier XS) to show that the new device is inserted through one incision and the old device removed through a separate incision at a separate anatomic site.I would apply this same guideline even if there is some “tunneling” under the surface of the skin to create a new pocket for the replacement device– one incision equals code 33285 only. If the original subcutaneous rhythm monitor is removed and a new device placed through the same incision, code for the insertion of the new device only (33285).So the final coding comes down to the timing of the two procedures and whether the new device is placed in the same location as the original device: The rationale for the edit is that the two codes represent “mutually exclusive procedures.” This means that the two codes cannot reasonably be reported together at the same anatomic site or at the same encounter. There is also an NCCI edit between codes 33285 (insertion of the new device) and 33286 (removal of the old). There is no dedicated code for replacement of a subcutaneous rhythm monitor. But how is a replacement of this device coded? You will notice that we have clear codes for insertion of a subcutaneous rhythm monitor (33285) and removal of one (33286). Patients with a prior MI and a measured Left Ventricular Ejection Fraction (LVEF) 0.30. In the other set of Pediatric codes, five new codes, 93593-93597, were developed for Cardiac Catheterization for Congenital Defects to replace codes 93530-93533, which have now been deleted. ICD-10-CM codes which describe the above: I46.2, I46.9, I47.20, I47.21, I47.29, I49.01, I49.02, I49.3, I49.9, I5A, Z45.02 or Z86.74. While most patients have the subcutaneous rhythm monitor inserted, are monitored, and then have the device removed (with or without placement of a pacemaker), some patients may require monitoring over a period of several years which could require replacement of the device. The codes are 33894-33897 for endovascular repair of coarctation with stent or angioplasty. Unlike a holter monitor which involves placement of electrodes and the use of an external recording device worn by the patient over a period of 2-15 days, these devices are useful for monitoring heart rhythm over a longer period of time when there is a need to better understand the trends and determine if a pacemaker is needed. A subcutaneous rhythm monitor (sometimes referred to as an implantable cardiac monitor or an implantable loop recorder) is a device inserted into a pocket underneath the skin that provides long-term monitoring of the patient’s heart rate. ![]()
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