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A subcutaneous rhythm monitor (sometimes referred to as an implantable cardiac monitor or an implantable loop recorder) is a device inserted into a pocket underneath the skin that provides long-term monitoring of the patient’s heart rate. Unlike a holter monitor which involves placement of electrodes and the use of an external recording device worn by the patient over a period of 2-15 days, these devices are useful for monitoring heart rhythm over a longer period of time when there is a need to better understand the trends and determine if a pacemaker is needed.
While most patients have the subcutaneous rhythm monitor inserted, are monitored, and then have the device removed (with or without placement of a pacemaker), some patients may require monitoring over a period of several years which could require replacement of the device. You will notice that we have clear codes for insertion of a subcutaneous rhythm monitor (33285) and removal of one (33286). But how is a replacement of this device coded?
It depends. There is no dedicated code for replacement of a subcutaneous rhythm monitor. There is also an NCCI edit between codes 33285 (insertion of the new device) and 33286 (removal of the old). The rationale for the edit is that the two codes represent “mutually exclusive procedures.” This means that the two codes cannot reasonably be reported together at the same anatomic site or at the same encounter.
So the final coding comes down to the timing of the two procedures and whether the new device is placed in the same location as the original device:
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