This installment of “Spotlight on CPT” will cover one of the changes to neurostimulator coding that took place in CPT on January 1st of 2024. First, let’s talk about what neurostimulators are. Medical devices that are implanted with the purpose of using electrical stimulation to disrupt pain signals are called neurostimulators. These programmable devices can treat chronic pain, Parkinson’s disease, epilepsy, and other conditions.
The 2024 updates to CPT included several changes to neurostimulator coding. One of the changes was the addition of codes in the cardiovascular system for a phrenic nerve stimulator system. This type of neurostimulator is used in the treatment of central sleep apnea, or used for individuals who have brainstem or spinal injuries above C4.
The phrenic nerve controls the diaphragm. When that muscle is stimulated by the nervous system, it causes the diaphragm to contract resulting in expansion of the lungs and inhalation.
The 2024 CPT code changes include new codes for the insertion of a phrenic nerve stimulator system.
Code 33276 is a comprehensive code which includes insertion of both the pulse generator and stimulating lead(s). Notice the add-on code 33277 which is assigned when the transvenous sensing lead is placed. If the sensing lead insertion is done at any time other than at the initial insertion of the phrenic nerve stimulator system, code 33999 for unlisted procedure, cardiac surgery should be assigned.
including vessel catheterization, all imaging guidance, and pulse generator initial analysis
with diagnostic mode activation, when performed
+33277 Insertion of phrenic nerve stimulator transvenous sensing lead
Since there are codes for insertion of these neurostimulators, there should also be codes for removal as noted below.
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
33280 pulse generator only
33279 is only assigned once as it covers removal of one or more leads.
In addition, if the transvenous lead would need repositioned, there is a new code to capture that service.
33281 Repositioning of phrenic nerve stimulator transvenous lead(s)
This code may only be assigned once per patient per day.
If a removal is immediately followed by replacement of a phrenic nerve stimulator, there are also new codes to report those procedures.
33287 Removal and replacement of phrenic nerve
stimulator, including vessel catheterization, all
imaging guidance, and
interrogation and programming, when
performed; pulse generator
33288 transvenous stimulation or sensing lead(s)
33288 is assigned only once for removal of one or more leads.
The next series of phrenic nerve stimulator codes concerns the activation, interrogation, and programming of the neurostimulator. These codes are located in the Medicine section of the CPT Manual.
93150 Therapy activation of implanted phrenic nerve stimulator system, including all interrogationand programming
93151 Interrogation and programming (minimum one parameter) of implanted phrenic nerve
stimulator system
93152 Interrogation and programming of implanted phrenic nerve stimulator system during
polysomnography
93153 Interrogation without programming of implanted phrenic nerve stimulator system
Now, light has been shed on coding phrenic nerve stimulator procedures.
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About the Author
Dianna Foley, RHIA, CHPS, CCS, CDIP, is an HIM professional with over 25 years of experience. She earned her bachelor’s degree from the University of Cincinnati and holds RHIA, CHPS, CDIP, and CCS certifications from AHIMA, along with being an AHIMA-approved ICD-10-CM/PCS trainer. Dianna has held many positions in HIM and is now an independent coding consultant. She previously served as the program director for Medical Coding and HIT at Eastern Gateway Community College. Dianna is an AHIMA-published author and has volunteered with AHIMA on projects including certification item writing, certification exam development, coding rapid design, and most recently has served on AHIMA’s nominating committee. She is a presenter on coding topics at the national, state, and regional levels and serves as OHIMA’s Education Coordinator. Dianna mentors new AHIMA members and also provides monthly educational lectures to coders and clinical documentation specialists.
