G9411 HCPCS Reimbursement & Policy Benchmarks | OpenPayer

Summary & Overview

HCPCS G9411: CIED Infection Requiring Device Removal or Surgical Revision

HCPCS Level II code G9411 represents care for patients who were not admitted within 180 days after a cardiovascular implantable electronic device (CIED) implantation, replacement, or revision when that index procedure was complicated by infection requiring device removal or surgical revision. This code identifies post-procedural infection events linked to device management and is relevant for inpatient and outpatient surgical billing and quality tracking nationwide. Key payers in the national landscape include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise explanation of the code’s clinical context, typical sites of service, and common billing considerations. The publication outlines what the code captures clinically, how major payers treat this service line, and where to look for related billing and policy guidance. It also flags areas where input data were not provided so readers can seek supplementary sources. This summary aims to support coding professionals, hospital billing leaders, and policy analysts in understanding the clinical scenario tied to G9411 and the types of claims activity this HCPCS Level II code represents.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicareG9411HCPCS Level IICIEDdevice infectiondevice removalsurgical revisioncardiac surgerypost-procedure complicationbilling

Billing Code Overview

HCPCS Level II code G9411 describes a patient who is not admitted within 180 days following a cardiovascular implantable electronic device (CIED) implantation, replacement, or revision when the procedure was associated with an infection requiring device removal or surgical revision. The service type is infection-related device removal or surgical revision associated with a CIED. The typical site of service is an inpatient or outpatient surgical setting where device explantation or revision for infection is performed.

Clinical & Coding Specifications

Clinical Context

A 68-year-old male with ischemic cardiomyopathy and a previously implanted cardiac implantable electronic device (CIED) presents with fever, erythema and purulent drainage at the left subclavian pocket site and positive blood cultures for Staphylococcus aureus. He is evaluated in the outpatient electrophysiology clinic and admitted to the ambulatory surgical center for device removal and pocket debridement. The procedure includes explantation of the generator and leads, wound irrigation, and plans for delayed reimplantation after clearance of infection. The clinical workflow includes pre-procedure evaluation (temperature, blood cultures, device interrogation), informed consent, peri-procedural antibiotics, device and lead extraction in the procedure suite, documentation of operative findings (pocket infection, lead vegetations), specimen collection for culture, and post-procedure wound care and follow-up.

Coding Specifications

Modifier	Description	When to Use
`22`	Increased procedural services	Use when work required is substantially greater than typically required (extensive infected tissue debridement beyond standard explantation).
`23`	Unusual anesthesia	Use when general anesthesia is required for a procedure normally done with local/regional anesthesia due to infection complexity or patient factors.

HCPCS G9997: Documentation of Patient Pregnancy During Measurement Period

HCPCS-G0919-INFLUENZA-IMMUNIZATION-ORDERED-RECOMMENDED-ALTERNATE-LOCATION

HCPCS G0919: Influenza Immunization Ordered or Recommended

HCPCS-G2181-BMI-NOT-DOCUMENTED-MEDICAL-REASON-OR-PATIENT-REFUSAL

HCPCS G2181: BMI Not Documented Due to Medical Reason or Patient Refusal

HCPCS-G9637-DOSE-REDUCTION-TECHNIQUES-REPORTING

HCPCS G9637: Final Report Documenting Imaging Dose Reduction Techniques

HCPCS-G0479-PRESUMPTIVE-DRUG-TESTING-INSTRUMENTED-ANALYZERS

HCPCS G0479: Presumptive Drug Test by Instrumented Chemistry Analyzers

HCPCS-G0493-SKILLED-NURSING-OBSERVATION-ASSESSMENT-HOME-HEALTH-HOSPICE

HCPCS G0493: Skilled Nursing Observation and Assessment, per 15 minutes

HCPCS-G2081-INSTITUTIONAL-SNP-LONG-TERM-CARE-90-DAYS

HCPCS G2081: Institutional SNP or Long-Term Care Residence >90 Days

HCPCS-G0277-HYPERBARIC-OXYGEN-THERAPY-FULL-BODY-CHAMBER-30-MIN

HCPCS G0277: Hyperbaric Oxygen Therapy, Full Body Chamber, 30-Min Intervals

HCPCS-G8873-NEEDLE-LOCALIZATION-NON-IMAGED-SPECIMEN-VERIFICATION

HCPCS G8873: Needle Localization Specimen Verification

HCPCS-G8547-ISCHEMIC-VASCULAR-DISEASE-MEASURES-REPORTING

HCPCS G8547: Intent to Report Ischemic Vascular Disease Measures

Showing 1–10 of 1996

Taxonomy Code	Specialty	Notes
207R00000X	Cardiology	Electrophysiologists and invasive cardiologists commonly perform CIED management and explantation.
2080P0003X	Surgery - Cardiothoracic	Cardiac surgeons participate in complex lead extraction or when vascular/atrial lead vegetations are present.
207RH0000X	Internal Medicine - Electrophysiology	Clinical cardiac electrophysiologists who manage device-related infections and perform generator/lead procedures.
363A00000X	Emergency Medicine	Emergency physicians may present and stabilize patients with device-related sepsis prior to definitive extraction.
367500000X	Infectious Disease	Infectious disease specialists direct antimicrobial therapy and determine timing of reimplantation.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`T82.7XXA`	Infection and inflammatory reaction due to other cardiac and vascular devices, implants and grafts, initial encounter	Primary diagnosis for CIED pocket or device-related infection requiring device removal or revision.
`T81.4XXA`	Infection following a procedure, initial encounter	Used when the infection is attributed to a prior device procedure and presents as a postoperative infection.
`I33.0`	Acute and subacute infective endocarditis	Relevant when lead-associated endocarditis or vegetations are identified, often necessitating full device extraction.
`R50.9`	Fever, unspecified	Symptom code supporting systemic infection workup in patients with device infections and positive blood cultures.
`A41.9`	Sepsis, unspecified organism	Used when bloodstream infection progresses to sepsis related to device infection and mandates device removal.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`33233`	Removal of permanent pacemaker pulse generator only; uncomplicated	Used when only the generator is removed without lead extraction for pocket infection management.
`33234`	Removal of permanent pacemaker pulse generator with replacement; with transvenous lead(s) left in place	Used when generator removal is accompanied by immediate replacement while leaving leads in situ when infection risk is managed.
`33235`	Removal of permanent pacemaker pulse generator with revision or replacement of transvenous lead(s)	Used when generator removal requires lead revision or replacement during the same encounter.
`33244`	Removal of epicardial lead(s) with or without replacement	Used for procedures involving epicardial systems or surgical lead removal when transvenous extraction is not applicable.
`33258`	Insertion of new or replacement of permanent pacemaker with transvenous electrode(s); single chamber	Used when reimplantation of a single-chamber device is performed after infection clearance, typically at a later date.

OpenPayer