HCPCS G9413: CIED Infection Requiring Device Removal or Surgical Revision

HCPCS Level II code G9413 denotes a patient not admitted within 180 days who is status post cardiac implantable electronic device (CIED) implantation, replacement, or revision complicated by infection requiring device removal or surgical revision. The code captures a specific clinical scenario tied to device-related infection management and surgical intervention, relevant to hospitals, surgical centers, and payers managing device complications nationwide.

Key payers covered in this analysis include Medicare, Aetna, Blue Cross Blue Shield, Cigna Health, and UnitedHealthcare. Readers will find a concise national overview of the code's clinical context, how it maps to surgical service lines and typical sites of care, and the policy and billing considerations that affect coverage and claims processing. The publication highlights common modifiers associated with surgical services, notes gaps where input data is unavailable, and outlines areas where institutions and payers often need clear documentation to support claims.

This briefing is intended to inform coding professionals, revenue cycle managers, and policy analysts about the clinical definition and billing context of G9413, typical care settings, and the payer landscape relevant to device infection removals and surgical revisions.

Billing Code Overview

HCPCS Level II code G9413 describes a patient who was not admitted within 180 days and is status post cardiac implantable electronic device (CIED) implantation, replacement, or revision with an infection requiring device removal or surgical revision.

Service type: Surgical management of infected CIED, including device removal and/or surgical revision
Typical site of service: Inpatient or outpatient hospital surgical setting, or ambulatory surgical center depending on clinical status and need for admission

Data not available in the input.

Clinical Context

A 68-year-old patient with a previously implanted cardiac implantable electronic device (CIED)—such as a pacemaker or implantable cardioverter-defibrillator (ICD)—presents to an outpatient electrophysiology clinic with localized pocket erythema, drainage, and systemic signs of infection (fever, elevated white blood cell count). Blood cultures are positive for Staphylococcus aureus. The patient is not admitted within the prior 180 days and requires device removal or surgical revision because of device-related infection. The typical clinical workflow includes outpatient evaluation by electrophysiology or cardiology, diagnostic testing (blood cultures, device pocket ultrasound or echocardiography if endocarditis suspected), antimicrobial therapy initiation, scheduling of device extraction or revision in an ambulatory surgery center or hospital outpatient department, and coordination for reimplantation planning once infection is controlled. Procedural consent, intraoperative cultures, and documentation of indication for extraction due to infection are included in the medical record. Post-procedure follow-up includes wound checks, continued antimicrobial therapy guided by cultures, and planning for reimplantation at a contralateral site when appropriate.

Coding Specifications

Modifier	Description	When to Use
`22`	Increased procedural services	Use when work required is substantially greater than typically required for device removal or revision due to extensive adhesions, infection-related debridement, or prolonged surgical time.

Taxonomy Code	Specialty	Notes
207RC0000X	Cardiac Electrophysiology	Electrophysiologists commonly perform device explantation and reimplantation planning.
208000000X	Cardiology	Interventional cardiologists or cardiologists evaluate device-related infections and coordinate care.
207L00000X	Cardiothoracic Surgery	Cardiothoracic surgeons may be involved for complex extractions or leads with endocardial adherence.
163W00000X	Family Medicine	In some outpatient settings, family medicine may coordinate initial presentation and referral.
2084P0800X	Internal Medicine	Hospitalists or internists manage inpatient antimicrobial therapy and perioperative medical optimization.

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	Directly describes infection of a CIED prompting removal or revision.
`T82.712A`	Infection and inflammatory reaction due to cardiac electronic device, initial encounter	Specifically indicates infection of an implanted cardiac electronic device.
`I33.0`	Infective endocarditis	Relevant when infection involves endocardial structures or leads causing bacteremia and need for device removal.
`B95.6`	Staphylococcus aureus as the cause of diseases classified elsewhere	Common pathogen for device-related infections; used as an additional code when organism identified.
`R65.20`	Severe sepsis without septic shock	May be relevant if device infection has caused systemic sepsis requiring urgent extraction.
`L02.91`	Cutaneous abscess, unspecified site	Pocket abscess at generator site can be coded when present as the local infectious focus.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`33233`	Removal of pacing cardioverter-defibrillator pulse generator only; without replacement	Used when the infected generator is removed and not immediately replaced.
`33234`	Removal of pacing cardioverter-defibrillator pulse generator only; with replacement of intracardiac lead(s) and/or subcutaneous electrode(s)	Used when generator removal is accompanied by replacement of leads or electrodes in the same encounter.
`33235`	Removal of pacing cardioverter-defibrillator pulse generator only; with replacement of pulse generator only	Used when the infected generator is removed and a new generator is implanted without lead revision.
`33244`	Insertion of new or replacement of permanent pacemaker with transvenous lead(s); single lead	Relevant when reimplantation after removal is performed with a single transvenous lead.
`33249`	Insertion of new or replacement of permanent pacemaker with transvenous lead(s); multiple lead	Relevant when reimplantation requires multiple transvenous leads.
`33350`	Insertion of new or replacement of implantable cardioverter-defibrillator pulse generator only	Used for generator replacement in ICD systems following explantation for infection.

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Summary & Overview