2025 CPT code 33214
Upgrade of implanted pacemaker system, conversion of single chamber system to dual chamber system (includes removal of previously placed pulse generator, testing of existing lead, insertion of new lead, insertion of new pulse generator).
Modifiers may be applicable in certain situations. For example, modifier 22 (Increased Procedural Services) may be used if the procedure is significantly more complex than usual due to patient anatomy or other factors.
Medical necessity for this procedure must be clearly documented.This could include symptoms like dizziness, fatigue, or syncope related to inadequate heart rate control, development of atrioventricular block, or management of arrhythmias like atrial fibrillation where dual-chamber pacing can improve cardiac function.The documentation should demonstrate that less invasive or conservative treatments have been considered or tried and were unsuccessful, and that the upgrade to a dual-chamber system is necessary for the patient's health and well-being.
The physician performs the procedure under appropriate anesthesia. They access the existing pacemaker pocket, remove the old generator, and insert a new lead transvenously into the right atrium. The existing lead in the right ventricle is tested to ensure proper function. A new dual-chamber pulse generator is connected to both leads and implanted in the pocket, and the incision is closed.
In simple words: A doctor upgrades a patient's heart pacemaker from a single-chamber to a dual-chamber system. This involves replacing the old pacemaker battery pack (pulse generator) and adding a new wire (lead) to the heart's upper right chamber (right atrium), while keeping and checking the current wire in the lower right chamber.All of this is done through a vein, so there's no major surgery.
This procedure involves upgrading a single-chamber pacemaker system to a dual-chamber system.The existing pulse generator is removed, the existing lead is tested, a new lead is inserted into the right atrium, and a new dual-chamber pulse generator is implanted. This procedure is performed transvenously.
Example 1: A patient with a single-chamber pacemaker experiences symptoms suggesting a need for improved heart rhythm coordination. They undergo an upgrade to a dual-chamber system for better heart rate control., A patient's single-chamber pacemaker battery is nearing its end of life.Concurrently, the patient develops symptoms suggestive of atrioventricular block. To address both issues, the physician upgrades the system to a dual-chamber pacemaker, replacing the generator and adding an atrial lead., A patient with a single-chamber pacemaker experiences frequent episodes of atrial fibrillation.To improve heart function and manage the atrial fibrillation, the cardiologist decides to upgrade the system to a dual-chamber device allowing for both atrial and ventricular pacing.
Documentation should include operative report detailing the procedure, including removal of the old generator, testing of the existing lead, placement of the new atrial lead, and insertion of the new dual-chamber generator. The report should also document the pre- and post-procedure device settings and any complications encountered.The medical record should justify the medical necessity of the upgrade with supporting clinical indications.
- Revenue Code: P2E
- Specialties:Cardiac Electrophysiology, Cardiothoracic Surgery
- Place of Service:Ambulatory Surgical Center, Hospital Inpatient, Hospital Outpatient