SUPPLEMENTAL MATERIAL Table S1. Patient Selection Codes, CIED Generator Procedures Code Type Code Description ICD9 Proc 00.51 Implantation of cardiac resynchronization defibrillator, total system [CRT-D] ICD9 Proc 00.54 Implantation or replacement of cardiac resynchronization defibrillator pulse generator only [CRT-D] ICD9 Proc 00.50 Implantation of cardiac resynchronization pacemaker without mention of defibrillation, total system [CRT-P] ICD9 Proc 00.53 Implantation or replacement of cardiac resynchronization pacemaker pulse generator only [CRT-P] CPT 33230 Insertion of implantable defibrillator pulse generator only; with existing dual leads CPT 33249 Insertion or replacement of permanent implantable defibrillator system, with transvenous lead(s), single or dual chamber CPT 33262 Removal of implantable defibrillator pulse generator with replacement of implantable defibrillator pulse generator; single lead system CPT 33263 Removal of implantable defibrillator pulse generator with replacement of implantable defibrillator pulse generator; dual lead system CPT 33231 Insertion of implantable defibrillator pulse generator only; with existing multiple leads CPT 33240 Insertion of implantable defibrillator pulse generator only; with existing single lead (before 2012 ICD or CRT-2; after 2012 ICD replacement) CPT 33249 Insertion or replacement of permanent implantable defibrillator system, with transvenous lead(s), single or dual chamber CPT 33264 Removal of implantable defibrillator pulse generator with replacement of implantable defibrillator pulse generator; multiple lead system ICD9 Proc 37.94 Implantation or replacement of automatic cardioverter/defibrillator, total system [AICD] ICD9 Proc 37.96 Implantation of automatic cardioverter/defibrillator pulse generator only ICD9 Proc 37.98 Replacement of automatic cardioverter/defibrillator pulse generator only CPT 33229 Removal of permanent pacemaker pulse generator with replacement of pacemaker pulse generator; multiple lead system
Code Type Code Description CPT 33206 Insertion of new or replacement of permanent pacemaker with transvenous electrode(s); atrial CPT 33207 Insertion of new or replacement of permanent pacemaker with transvenous electrode(s) CPT 33208 Insertion of new or replacement of permanent pacemaker with transvenous electrode(s); atrial and ventricular CPT 33212 Insertion of pacemaker pulse generator only; with existing single lead CPT 33213 Insertion of pacemaker pulse generator only; with existing dual leads CPT 33221 Insertion of pacemaker pulse generator only; with existing multiple leads CPT 33227 Removal of permanent pacemaker pulse generator with replacement of pacemaker pulse generator; single lead system CPT 33228 Removal of permanent pacemaker pulse generator with replacement of pacemaker pulse generator; dual lead system CPT 33214 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 37.80 Insertion of permanent pacemaker, initial or replacement, type of device not specified ICD9 Proc 37.85 Replacement of any type pacemaker device with single-chamber device, not specified as rate responsive ICD9 Proc 37.86 Replacement of any type of pacemaker device with single-chamber device, rate responsive ICD9 Proc 37.87 Replacement of any type pacemaker device with dual-chamber device ICD9 Proc 37.89 Revision or removal of pacemaker device
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 3720-3729 Diagnostic Procedures On Heart And Pericardium Percutaneous coronary intervention ICD9 Proc 0066 Percutaneous transluminal coronary angioplasty ICD9 Proc 3603-3609 Removal Of Coronary Artery Obstruction And Insertion Of Stent(s) CPT 37184 Primary percutaneous transluminal mechanical thrombectomy, noncoronary, arterial or arterial bypass graft, including fluoroscopic guidance and intraprocedural pharmacological thrombolytic injection(s); initial vessel CPT 37185 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 37186 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 3610-3619 Bypass Anastomosis For Heart Revascularization CPT 33736 Atrial septectomy or septostomy; open heart with cardiopulmonary bypass CPT 33774 Repair of transposition of the great arteries, atrial baffle procedure (eg, Mustard or Senning type) with cardiopulmonary bypass; CPT 33775 Repair of transposition of the great arteries, atrial baffle procedure (eg, Mustard or Senning type) with cardiopulmonary bypass; with removal of pulmonary band CPT 33776 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 33777 Repair of transposition of the great arteries, atrial baffle procedure (eg, Mustard or Senning type) with cardiopulmonary bypass; with repair of subpulmonic obstruction
Procedure Type Code Type Code Description Catheter ablation ICD9 Proc 3734 Excision or destruction of other lesion or tissue of heart, endovascular approach CPT 93651 Intracardiac catheter ablation of arrhythmogenic focus CPT 93657 Additional linear or focal intracardiac catheter ablation of the left or right atrium for treatment of atrial fibrillation CPT 33251 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 33254 Operative tissue ablation and reconstruction of atria, limited (eg, modified maze procedure) CPT 33255 Operative tissue ablation and reconstruction of atria, extensive (eg, maze procedure); without cardiopulmonary bypass CPT 33256 Operative tissue ablation and reconstruction of atria, extensive (eg, maze procedure); with cardiopulmonary bypass CPT 33261 Operative ablation of ventricular arrhythmogenic focus with cardiopulmonary bypass CPT 33265 Endoscopy, surgical; operative tissue ablation and reconstruction of atria, limited (eg, modified maze procedure), without cardiopulmonary bypass CPT 33266 Endoscopy, surgical; operative tissue ablation and reconstruction of atria, extensive (eg, maze procedure), without cardiopulmonary bypass Heart valve surgery ICD9 Proc 3500-3509 Operations On Valves And Septa Of Heart CPT 33361 Transcatheter aortic valve replacement (TAVR/TAVI) with prosthetic valve; percutaneous femoral artery approach CPT 33362 Transcatheter aortic valve replacement (TAVR/TAVI) with prosthetic valve; open femoral artery approach CPT 33363 Transcatheter aortic valve replacement (TAVR/TAVI) with prosthetic valve; open axillary artery approach CPT 33364 Transcatheter aortic valve replacement (TAVR/TAVI) with prosthetic valve; open iliac artery approach CPT 33365 Transcatheter aortic valve replacement (TAVR/TAVI) with prosthetic valve; transaortic approach (eg, median sternotomy, mediastinotomy) CPT 33367 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)
Procedure Type Code Type Code Description CPT 33368 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 33369 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 33400 Valvuloplasty, aortic valve; open, with cardiopulmonary bypass CPT 33401 Valvuloplasty, aortic valve; open, with inflow occlusion CPT 33403 Valvuloplasty, aortic valve; using transventricular dilation, with cardiopulmonary bypass CPT 33405 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 33203 Insertion of epicardial electrode(s); endoscopic approach CPT 33244 Removal of single or dual chamber implantable defibrillator electrode(s); by transvenous extraction CPT 33202 Insertion of epicardial electrode(s); open incision CPT 33220 Repair of 2 transvenous electrodes for permanent pacemaker or implantable defibrillator ICD9 Proc 37.95 Implantation of automatic cardioverter/defibrillator lead(s) only ICD9 Proc 37.97 Replacement of automatic cardioverter/defibrillator lead(s) only ICD9 Proc 37.74 Insertion or replacement of epicardial lead [electrode] into epicardium ICD9 Proc 37.76 Replacement of transvenous atrial and/or ventricular lead(s) [electrode] ICD9 Proc 37.77 Removal of lead(s) [electrode] without replacement ICD9 Proc 37.95 Implantation of automatic cardioverter/defibrillator lead(s) only ICD9 Proc 37.97 Replacement of automatic cardioverter/defibrillator lead(s) only
Procedure Type Code Type Code Description ICD9 Proc 00.52 Implantation or replacement of transvenous lead [electrode] into left ventricular coronary venous system ICD9 Proc 37.74 Insertion or replacement of epicardial lead [electrode] into epicardium ICD9 Proc 37.75 Revision of lead [electrode] ICD9 Proc 37.76 Replacement of transvenous atrial and/or ventricular lead(s) [electrode] ICD9 Proc 37.77 Removal of lead(s) [electrode] without replacement ICD9 Proc 37.75 Revision of lead [electrode] ICD9 Proc 37.78 Insertion of temporary transvenous pacemaker system CPT 33222 Relocation of skin pocket for pacemaker CPT 33223 Relocation of skin pocket for implantable defibrillator ICD9 Proc 37.79 Revision or relocation of cardiac device pocket
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 93279 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 93280 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 93281 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 93282 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 93283 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 93284 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 93286 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 93287 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 93288 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 93289 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
Code Type Code Description CPT 93294 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 93295 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 93296 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 93642 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 93724 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 93299 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 93731 93280 after 12/31/2009 CPT 93732 93280 after 12/31/2009 CPT 93733 93293 after 2009 CPT 93293 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 93734 93288 after 2009 CPT 93735 93279 after 2009 CPT 93736 93293 after 2009 CPT 93741 93289 after 2009 CPT 93742 93282 after 2009 CPT 93743 93289 after 2009 CPT 93744 93283 or 93284 after 2009 ICD9 Dx V45.01 Cardiac pacemaker in situ
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 89.45 Artificial pacemaker rate check ICD9 Proc 89.46 Artificial pacemaker artifact wave form check ICD9 Proc 89.47 Artificial pacemaker electrode impedance check ICD9 Proc 89.48 Artificial pacemaker voltage or amperage threshold check ICD9 Proc 89.49 Automatic implantable cardioverter/defibrillator (AICD) check ICD9 Proc 37.20 Noninvasive programmed electrical stimulation [NIPS]