Basics of CPT code 33276, 33277, 33278, 33279, 33280, 33281, 33287, 33288
For the CPT 2024 code set, eight new codes (33276-33281, 33287, 33288) were established in the Heart and Pericardium Pacemaker or Implantable Defibrillator subsection of the Cardiovascular System section to report insertion, removal, repositioning, and replacement of a phrenic nerve stimulator system and/or its components. Category III codes 0424T-0436T were deleted and new guidelines, headings, and parenthetical notes were included to provide instructions regarding appropriate reporting for these services.
In addition, four new codes (93150-93153) were established to report programming for phrenic nerve stimulation system in the Medicine Cardiovascular/Implantable, Insertable, and Wearable Cardiac Device Evaluations subsection. New guidelines and parenthetical notes were included to provide instructions regarding the appropriate reporting of these codes. This article provides an overview of these changes and the intent and use of these new codes.
Coding description of of CPT 33276, 33277, 33278, 33279, 33280, 33281, 33287, 33288
Insertion of a phrenic nerve stimulation system includes a pulse generator (containing electronics and a battery) and one stimulation lead and is reported with 33276. Pulse generators are placed in a submuscular or subcutaneous “pocket” in the pectoral region. The stimulation lead is placed transvenously into the right brachiocephalic vein or left pericardiophrenic vein. Rarely, a separate sensing lead may be needed to augment system function and, when performed at time of system insertion, is reported with 33277.
This sensing lead is placed transvenously into the azygos vein. Initial system placement includes initiation of diagnostic mode and associated system evaluation. Codes 33276, 33277, 33278, 33279, 33280, 33281, 33287, 33288 include vessel catheterization and all imaging guidance required for the procedure, when performed. For therapeutic activation of the phrenic nerve stimulation system, see 93150, 93151, 93152, 93153.
33276 Insertion of phrenic nerve stimulator system (pulse generator and stimulating lead[s]), including vessel catheterization, all imaging guidance, and pulse generator initial analysis with diagnostic mode activation, when performed
(Do not report 33276 in conjunction with 93150, 93151, 93152, 93153)
33277 Insertion of phrenic nerve stimulator transvenous sensing lead (List separately in addition to code for primary procedure)
(Use 33277 in conjunction with 33276, 33287)
(For insertion of a phrenic nerve sensing lead other than at initial insertion of the phrenic nerve stimulator system, use 33999)
33278 Removal of phrenic nerve stimulator, including vessel catheterization, all imaging guidance, and interrogation and programming, when performed; system, including pulse generator and lead(s)
33279 transvenous stimulation or sensing lead(s) only
(Use 33279 once for removal of one or more lead[s])
33280 pulse generator only
(Do not report 33278, 33279, 33280 in conjunction with 33276, 33277, 33281, 33287,
33288)
33281 Repositioning of phrenic nerve stimulator transvenous lead(s)
(Do not report 33281 in conjunction with 33276, 33277)
(Report 33281 only once per patient per day)
33287 Removal and replacement of phrenic nerve stimulator, including vessel catheterization, all imaging guidance, and interrogation and programming, when performed; pulse generator
(Do not report 33287 in conjunction with 33276, 33278)
33288 transvenous stimulation or sensing lead(s)
(Use 33288 once for removal of one or more lead[s])
(Do not report 33288 in conjunction with 33277, 33279, 33281)
Codes 33276-33281, 33287, and 33288 were created to distinguish the different parts of phrenic nerve stimulation system services, which may be used to treat moderate to severe central sleep apnea by stimulation of the phrenic nerve to control breathing. These services include procedures for insertion (33276, 33277), removal (33278-33280), repositioning (33281), and removal and replacement (33287, 33288) of phrenic nerve stimulation devices or their components. As stated in the guidelines, the insertion of a phrenic nerve simulation system includes a pulse generator (containing electronics and a battery) and one stimulation lead and is reported with code 33276.
As noted in the descriptor for code 33276, device placement (accomplished intravascularly), imaging guidance, and pulse generator initial analysis with diagnostic mode activation are all commonly performed for services related to these devices. Therefore, these commonly performed services are inherent to the procedures for insertion of phrenic nerve stimulator system and should not be separately reported. Guidelines and exclusionary and cross-reference parenthetical notes were added to provide instructions on the appropriate reporting, which include:
- reporting when a separate sensing lead is necessary to augment system function;
- reporting catheterization and imaging;
- reporting sensing lead placement when performed at a time other than the initial insertion (33999);
- restrictions when reporting the removal of one or more lead(s) (33279, 33288);
- the number of times that repositioning (33281) may be reported per day;
- restrictions when reporting programming (93150-93153) that was not performed separately from the
- insertion procedure (33276); and
- a cross-reference to the therapeutic activation codes (93150-93153).
Category III codes 0424T-0436T and all their related references were deleted. Parenthetical notes were created to direct users to the appropriate new Category I codes for these services. In addition, four new codes (93150-93153), guidelines, and parenthetical instructions were added to the new subsection of the Phrenic Nerve Stimulation System in the Medicine section to report therapeutic activation services.
Reference: CPT code assistant April 2024
