by David Zielske, MD, CIRCC, COC, CCVTC, CCC, CCS, RCC
Question:
How would I code for the removal of a Substernal (extravascular, or “EV”) ICD with insertion of a biventricular ICD at the same operative session? When I try to code 0573T and 0580T (removal of ICD and substernal lead) with the insertion of the biventricular ICD (33249, 33225), it comes up with the zero edit that these absolutely cannot be coded together.
Per the OR report: “Incised over the subcostal subxiphoid incision cut down to the silastic collar removed the ties from the silastic collar and removed the lead from the sub lateral sternal area, I then made incision over the lateral axillary region down to the pocket remove the device from the pocket and then was able to pull the lead through to the left axillary region and the device was removed. Then they placed new RA and RV lead followed by LV lead and placed new ICD in pocket.”
Is there any way to account for both procedures?
Answer:
We are aware of edits between substernal (extravascular) ICDs and transvenous ICDs. A substernal (extravascular) is for those requiring intermittent pacing, while transvenous is for need of permanent pacing. We have no idea why zero edits exist between them. We have requested CMS to reconsider their edit. You should too!
Also for you …
Complete Interventional Radiology and Cardiovascular Coding
From ZHealth Publishing, the experts in coding of IR/CV procedures. Detailed information on a broad range of Interventional Radiology and Cardiovascular procedures and the guidelines for proper coding. 41 AAPC CEUs!
More info
Nashville, TN, June 2-6, 2025
IR/CV Medical Coding Seminars
Virtual + Live. Earn up to 27.5 AAPC CEUs and 31.5 ASRT CEUs.
More info
