SUPPLEMENTAL MATERIAL

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1 SUPPLEMENTAL MATERIAL Table S1. Patient Selection Codes, CIED Generator Procedures Code Type Code Description ICD9 Proc Implantation of cardiac resynchronization defibrillator, total system [CRT-D] ICD9 Proc Implantation or replacement of cardiac resynchronization defibrillator pulse generator only [CRT-D] ICD9 Proc Implantation of cardiac resynchronization pacemaker without mention of defibrillation, total system [CRT-P] ICD9 Proc Implantation or replacement of cardiac resynchronization pacemaker pulse generator only [CRT-P] CPT Insertion of implantable defibrillator pulse generator only; with existing dual leads CPT Insertion or replacement of permanent implantable defibrillator system, with transvenous lead(s), single or dual chamber CPT Removal of implantable defibrillator pulse generator with replacement of implantable defibrillator pulse generator; single lead system CPT Removal of implantable defibrillator pulse generator with replacement of implantable defibrillator pulse generator; dual lead system CPT Insertion of implantable defibrillator pulse generator only; with existing multiple leads CPT Insertion of implantable defibrillator pulse generator only; with existing single lead (before 2012 ICD or CRT-2; after 2012 ICD replacement) CPT Insertion or replacement of permanent implantable defibrillator system, with transvenous lead(s), single or dual chamber CPT Removal of implantable defibrillator pulse generator with replacement of implantable defibrillator pulse generator; multiple lead system ICD9 Proc Implantation or replacement of automatic cardioverter/defibrillator, total system [AICD] ICD9 Proc Implantation of automatic cardioverter/defibrillator pulse generator only ICD9 Proc Replacement of automatic cardioverter/defibrillator pulse generator only CPT Removal of permanent pacemaker pulse generator with replacement of pacemaker pulse generator; multiple lead system

2 Code Type Code Description CPT Insertion of new or replacement of permanent pacemaker with transvenous electrode(s); atrial CPT Insertion of new or replacement of permanent pacemaker with transvenous electrode(s) CPT Insertion of new or replacement of permanent pacemaker with transvenous electrode(s); atrial and ventricular CPT Insertion of pacemaker pulse generator only; with existing single lead CPT Insertion of pacemaker pulse generator only; with existing dual leads CPT Insertion of pacemaker pulse generator only; with existing multiple leads CPT Removal of permanent pacemaker pulse generator with replacement of pacemaker pulse generator; single lead system CPT Removal of permanent pacemaker pulse generator with replacement of pacemaker pulse generator; dual lead system CPT Upgrade of implanted pacemaker system, conversion of single chamber system to dual chamber system (includes removal of previously placed pulse generator, testing of existing lead, insertion of new lead, insertion of new pulse generator) ICD9 Proc Insertion of permanent pacemaker, initial or replacement, type of device not specified ICD9 Proc Replacement of any type pacemaker device with single-chamber device, not specified as rate responsive ICD9 Proc Replacement of any type of pacemaker device with single-chamber device, rate responsive ICD9 Proc Replacement of any type pacemaker device with dual-chamber device ICD9 Proc Revision or removal of pacemaker device

3 Table S2. Patient Selection Codes, Exclusionary Criteria Procedure Type Code Type Code Description EXCLUDE if any code below occurred during index visit: Diagnostic procedures on heart and pericardium ICD9 Proc Diagnostic Procedures On Heart And Pericardium Percutaneous coronary intervention ICD9 Proc 0066 Percutaneous transluminal coronary angioplasty ICD9 Proc Removal Of Coronary Artery Obstruction And Insertion Of Stent(s) CPT Primary percutaneous transluminal mechanical thrombectomy, noncoronary, arterial or arterial bypass graft, including fluoroscopic guidance and intraprocedural pharmacological thrombolytic injection(s); initial vessel CPT Primary percutaneous transluminal mechanical thrombectomy, noncoronary, arterial or arterial bypass graft, including fluoroscopic guidance and intraprocedural pharmacological thrombolytic injection(s); second and all subsequent vessel(s) within the same vascular family (List separately in addition to code for primary mechanical thrombectomy procedure) CPT Secondary percutaneous transluminal thrombectomy (eg, nonprimary mechanical, snare basket, suction technique), noncoronary, arterial or arterial bypass graft, including fluoroscopic guidance and intraprocedural pharmacological thrombolytic injections, provided in conjunction with another percutaneous intervention other than primary mechanical thrombectomy (List separately in addition to code for primary procedure) Coronary bypass graft surgery ICD9 Proc Bypass Anastomosis For Heart Revascularization CPT Atrial septectomy or septostomy; open heart with cardiopulmonary bypass CPT Repair of transposition of the great arteries, atrial baffle procedure (eg, Mustard or Senning type) with cardiopulmonary bypass; CPT Repair of transposition of the great arteries, atrial baffle procedure (eg, Mustard or Senning type) with cardiopulmonary bypass; with removal of pulmonary band CPT Repair of transposition of the great arteries, atrial baffle procedure (eg, Mustard or Senning type) with cardiopulmonary bypass; with closure of ventricular septal defect CPT Repair of transposition of the great arteries, atrial baffle procedure (eg, Mustard or Senning type) with cardiopulmonary bypass; with repair of subpulmonic obstruction

4 Procedure Type Code Type Code Description Catheter ablation ICD9 Proc 3734 Excision or destruction of other lesion or tissue of heart, endovascular approach CPT Intracardiac catheter ablation of arrhythmogenic focus CPT Additional linear or focal intracardiac catheter ablation of the left or right atrium for treatment of atrial fibrillation CPT Operative ablation of supraventricular arrhythmogenic focus or pathway (eg, Wolff-Parkinson-White, atrioventricular node re-entry), tract(s) and/or focus (foci); with cardiopulmonary bypass CPT Operative tissue ablation and reconstruction of atria, limited (eg, modified maze procedure) CPT Operative tissue ablation and reconstruction of atria, extensive (eg, maze procedure); without cardiopulmonary bypass CPT Operative tissue ablation and reconstruction of atria, extensive (eg, maze procedure); with cardiopulmonary bypass CPT Operative ablation of ventricular arrhythmogenic focus with cardiopulmonary bypass CPT Endoscopy, surgical; operative tissue ablation and reconstruction of atria, limited (eg, modified maze procedure), without cardiopulmonary bypass CPT Endoscopy, surgical; operative tissue ablation and reconstruction of atria, extensive (eg, maze procedure), without cardiopulmonary bypass Heart valve surgery ICD9 Proc Operations On Valves And Septa Of Heart CPT Transcatheter aortic valve replacement (TAVR/TAVI) with prosthetic valve; percutaneous femoral artery approach CPT Transcatheter aortic valve replacement (TAVR/TAVI) with prosthetic valve; open femoral artery approach CPT Transcatheter aortic valve replacement (TAVR/TAVI) with prosthetic valve; open axillary artery approach CPT Transcatheter aortic valve replacement (TAVR/TAVI) with prosthetic valve; open iliac artery approach CPT Transcatheter aortic valve replacement (TAVR/TAVI) with prosthetic valve; transaortic approach (eg, median sternotomy, mediastinotomy) CPT Transcatheter aortic valve replacement (TAVR/TAVI) with prosthetic valve; cardiopulmonary bypass support with percutaneous peripheral arterial and venous cannulation (eg, femoral vessels) (List separately in addition to code for primary procedure)

5 Procedure Type Code Type Code Description CPT Transcatheter aortic valve replacement (TAVR/TAVI) with prosthetic valve; cardiopulmonary bypass support with open peripheral arterial and venous cannulation (eg, femoral, iliac, axillary vessels) (List separately in addition to code for primary procedure) CPT Transcatheter aortic valve replacement (TAVR/TAVI) with prosthetic valve; cardiopulmonary bypass support with central arterial and venous cannulation (eg, aorta, right atrium, pulmonary artery) (List separately in addition to code for primary procedure) CPT Valvuloplasty, aortic valve; open, with cardiopulmonary bypass CPT Valvuloplasty, aortic valve; open, with inflow occlusion CPT Valvuloplasty, aortic valve; using transventricular dilation, with cardiopulmonary bypass CPT Replacement, aortic valve, with cardiopulmonary bypass; with prosthetic valve other than homograft or stentless valve EXCLUDE if any code below occurred in 1 year baseline (ensure index event isn't related to prior lead or pocket complications): CPT Insertion of epicardial electrode(s); endoscopic approach CPT Removal of single or dual chamber implantable defibrillator electrode(s); by transvenous extraction CPT Insertion of epicardial electrode(s); open incision CPT Repair of 2 transvenous electrodes for permanent pacemaker or implantable defibrillator ICD9 Proc Implantation of automatic cardioverter/defibrillator lead(s) only ICD9 Proc Replacement of automatic cardioverter/defibrillator lead(s) only ICD9 Proc Insertion or replacement of epicardial lead [electrode] into epicardium ICD9 Proc Replacement of transvenous atrial and/or ventricular lead(s) [electrode] ICD9 Proc Removal of lead(s) [electrode] without replacement ICD9 Proc Implantation of automatic cardioverter/defibrillator lead(s) only ICD9 Proc Replacement of automatic cardioverter/defibrillator lead(s) only

6 Procedure Type Code Type Code Description ICD9 Proc Implantation or replacement of transvenous lead [electrode] into left ventricular coronary venous system ICD9 Proc Insertion or replacement of epicardial lead [electrode] into epicardium ICD9 Proc Revision of lead [electrode] ICD9 Proc Replacement of transvenous atrial and/or ventricular lead(s) [electrode] ICD9 Proc Removal of lead(s) [electrode] without replacement ICD9 Proc Revision of lead [electrode] ICD9 Proc Insertion of temporary transvenous pacemaker system CPT Relocation of skin pocket for pacemaker CPT Relocation of skin pocket for implantable defibrillator ICD9 Proc Revision or relocation of cardiac device pocket

7 Table S3: Patient Selection Codes Additional Inclusion Criteria to Ensure Index Visit for Device Replacement Code Type Code Description Require 1 device monitoring, history code in 1 year baseline to ensure Index Event is a replacement procedure (not new generator placement): CPT Programming device evaluation (in person) with iterative adjustment of the implantable device to test the function of the device and select optimal permanent programmed values with analysis, review and report by a physician or other qualified health care professional; single lead pacemaker system CPT Programming device evaluation (in person) with iterative adjustment of the implantable device to test the function of the device and select optimal permanent programmed values with analysis, review and report by a physician or other qualified health care professional; dual lead pacemaker system CPT Programming device evaluation (in person) with iterative adjustment of the implantable device to test the function of the device and select optimal permanent programmed values with analysis, review and report by a physician or other qualified health care professional; multiple lead pacemaker system CPT Programming device evaluation (in person) with iterative adjustment of the implantable device to test the function of the device and select optimal permanent programmed values with analysis, review and report by a physician or other qualified health care professional; single lead transvenous implantable defibrillator system CPT Programming device evaluation (in person) with iterative adjustment of the implantable device to test the function of the device and select optimal permanent programmed values with analysis, review and report by a physician or other qualified health care professional; dual lead transvenous implantable defibrillator system CPT Programming device evaluation (in person) with iterative adjustment of the implantable device to test the function of the device and select optimal permanent programmed values with analysis, review and report by a physician or other qualified health care professional; multiple lead transvenous implantable defibrillator system CPT Peri-procedural device evaluation (in person) and programming of device system parameters before or after a surgery, procedure, or test with analysis, review and report by a physician or other qualified health care professional; single, dual, or multiple lead pacemaker system CPT Peri-procedural device evaluation (in person) and programming of device system parameters before or after a surgery, procedure, or test with analysis, review and report by a physician or other qualified health care professional; single, dual, or multiple lead implantable defibrillator system CPT Interrogation device evaluation (in person) with analysis, review and report by a physician or other qualified health care professional, includes connection, recording and disconnection per patient encounter; single, dual, or multiple lead pacemaker system CPT Interrogation device evaluation (in person) with analysis, review and report by a physician or other qualified health care professional, includes connection, recording and disconnection per patient encounter; single, dual, or multiple lead transvenous implantable defibrillator system, including analysis of heart rhythm derived data elements

8 Code Type Code Description CPT Interrogation device evaluation(s) (remote), up to 90 days; single, dual, or multiple lead pacemaker system with interim analysis, review(s) and report(s) by a physician or other qualified health care professional CPT Interrogation device evaluation(s) (remote), up to 90 days; single, dual, or multiple lead implantable defibrillator system with interim analysis, review(s) and report(s) by a physician or other qualified health care professional CPT Interrogation device evaluation(s) (remote), up to 90 days; single, dual, or multiple lead pacemaker system or implantable defibrillator system, remote data acquisition(s), receipt of transmissions and technician review, technical support and distribution of results CPT Electrophysiologic evaluation of single or dual chamber transvenous pacing cardioverter-defibrillator (includes defibrillation threshold evaluation, induction of arrhythmia, evaluation of sensing and pacing for arrhythmia termination, and programming or reprogramming of sensing or therapeutic parameters) CPT Electronic analysis of antitachycardia pacemaker system (includes electrocardiographic recording, programming of device, induction and termination of tachycardia via implanted pacemaker, and interpretation of recordings) CPT Interrogation device evaluation(s), (remote) up to 30 days; implantable cardiovascular monitor system or implantable loop recorder system, remote data acquisition(s), receipt of transmissions and technician review, technical support and distribution of results CPT after 12/31/2009 CPT after 12/31/2009 CPT after 2009 CPT Transtelephonic rhythm strip pacemaker evaluation(s) single, dual, or multiple lead pacemaker system, includes recording with and without magnet application with analysis, review and report(s) by a physician or other qualified health care professional, up to 90 days CPT after 2009 CPT after 2009 CPT after 2009 CPT after 2009 CPT after 2009 CPT after 2009 CPT or after 2009 ICD9 Dx V45.01 Cardiac pacemaker in situ

9 Code Type Code Description ICD9 Dx V45.02 Automatic implantable cardiac defibrillator in situ ICD9 Dx V53.31 Fitting and adjustment of cardiac pacemaker ICD9 Dx V53.32 Fitting and adjustment of automatic implantable cardiac defibrillator ICD9 Proc Artificial pacemaker rate check ICD9 Proc Artificial pacemaker artifact wave form check ICD9 Proc Artificial pacemaker electrode impedance check ICD9 Proc Artificial pacemaker voltage or amperage threshold check ICD9 Proc Automatic implantable cardioverter/defibrillator (AICD) check ICD9 Proc Noninvasive programmed electrical stimulation [NIPS]

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