2025 CPT code 33228
(Active) Effective Date: N/A Revision Date: N/A Cardiovascular Surgery - Cardiac Pacemaker Procedures Surgery Feed
Removal and replacement of a permanent pacemaker pulse generator; dual-lead system.
Modifiers may be applicable depending on the circumstances. For instance, modifier 59 may be used if the replacement is considered distinct from other procedures performed during the same session. Modifier 22 might be used if significant additional work was performed.
Medical necessity for a pacemaker generator replacement is established when the existing device malfunctions or the battery depletes, leading to inadequate cardiac pacing and potential life-threatening arrhythmias. The replacement is necessary to restore appropriate heart rhythm and prevent adverse cardiovascular events.
The clinical responsibility lies with the cardiologist or cardiac surgeon. This includes pre-operative assessment, the surgical procedure itself, post-operative care, and device programming. The procedure necessitates a skilled professional capable of managing potential complications.
In simple words: The doctor removes the old pacemaker and puts in a new one.This pacemaker has wires going to two parts of the heart.
This CPT code encompasses the removal of an existing permanent pacemaker pulse generator, followed by the insertion of a new pulse generator.The procedure specifically involves a dual-lead system, meaning the pacemaker has leads in two chambers of the heart (typically the right atrium and right ventricle). The code includes all necessary steps, such as opening the subcutaneous pocket, disconnecting and reconnecting the leads, and programming the new device.Radiological supervision and interpretation are considered inherent to the procedure and are not separately reportable.
Example 1: A 70-year-old patient with a dual-chamber pacemaker experiences battery depletion. The cardiologist performs a generator replacement using code 33228., A 65-year-old patient with a dual-chamber pacemaker experiences malfunction. The cardiologist removes the malfunctioning generator and replaces it with a newer model using code 33228., An 80-year-old patient requires an upgrade from a single-chamber pacemaker to a dual-chamber system. The physician performs a generator replacement, including lead insertion, coded with 33214, which is not 33228.
Pre-operative assessment including patient history, physical examination, and relevant diagnostic tests (e.g., ECG, chest X-ray).Intraoperative documentation detailing the surgical technique, lead integrity checks, and device programming parameters. Post-operative notes including patient recovery and device functionality verification.
** Thorough documentation, including device specifics and pre- and post-operative findings, is crucial for appropriate code assignment and reimbursement. Always cross-reference the procedure with current NCCI guidelines and payer-specific policies.
- RVU: The RVUs for this code vary by location and payer, but generally fall within the range of 5.00-6.00.Consult your local Medicare fee schedule or the payer's specific reimbursement rates for the most accurate values.
- Global Days: The global period for this procedure is typically included within the code itself and does not necessitate separate reporting of post-operative care.
- Payment Status: Active
- Modifier TC rule: No TC modifier is typically applied to this code. This is because the entire procedure is considered a single comprehensive service.
- Fee Schedule: Fee schedules are subject to change based on geographic location and payer.Consult your local Medicare fee schedule and/or payer-specific information for the most up-to-date data.
- Specialties:Cardiology, Cardiac Surgery
- Place of Service:Inpatient Hospital, Outpatient Hospital, Ambulatory Surgical Center