We have a provider performing endocardial left ventricular septal pacing, in which the pacing wire is inserted just below the HIS bundle and is threaded down to the left ventricular and screwed into LV septal wall.
BIV pacing (33225) is where the lead is inserted in the left ventricular chamber of the heart usually the coronary sinus.
Both paces the left ventricle, but wires are placed in different positions one in the left ventricle and the other is screwed into LV septal wall.
The use of the LVs as LV pacing site in CRT improves synchronization and acute hemodynamics comparably to conventional biventricular pacing in dyssynchronous canines and in patients. In addition, LVs stimulation may reduce dispersion of repolarization compared to epicardial pacing.
Also, for facility of the reporting for 33225 there is a special lead that is typically used with this as it is designed for placement through the coronary venous system to achieve LV pacing; the LV coronary sinus venous lead is represented by HCPCS C1900.
For facility reporting the 33225 has mandatory device criteria reporting that restricts this to only be reported with this supply as it represents coronary venous placement and the lead is unique only to that placement technique represented by 33225.
The CPT guidelines for 33225 only approximates the procedure description; it does describe the LV pacing but NOT by coronary venous placement of the lead.
Can we bill 33225 for the LV Septal pacing since although it is not pacing in the LT Ventricle chamber, it is pacing the LV by placement in the lt ventricle septum wall?
Or, should we bill this as unlisted 33999?
I would suggest reporting the unlisted code and sending documentation since the description does not state “septum” and is not mentioned with 33225.
Now to address the understanding that the supply code C1900 (lead), is only for certain lead placement and was placed somewhere different than the chamber. Again, your documentation should explain the procedure and why the lead was used with the unlisted procedure 33999.
It is important to mention although you are using an unlisted code, the work and risk involved is comparable to CPT 33225. This will give your payer a better understanding of the procedure and help with pricing.
In your attached documentation be sure to address the lead (C1900) and the unlisted procedure with the understanding their rules require C1900 to only be reported with 33999.
I would suggest you take this directly to your provider representative; it sounds like there may need to be some rule changes for your provider to bill C1900 with 33999, or perhaps the payer can add 33999 to an allowable code for C1900.
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