Tracy Blevins, MSHIM, RHIA • July 20, 2026
Coding the Medtronic Micra AV2 and VR2 Leadless Pacemakers: What Inpatient Coders Need to Know
*Summary
- The correct ICD-10 code for pacemaker insertion depends on where the Micra device is anchored — right ventricle or ventricular septum
- A new ICD-10-PCS code (02HM3NZ) was added effective April 1, 2026 for Micra placement in the ventricular septum
- The Micra AV2 pacemaker provides dual-chamber sensing with AV synchrony; the Micra VR2 is a single chamber pacemaker for ventricular rate response only
- Both the Micra AV2 and VR2 use device value N (Intracardiac Pacemaker) in ICD-10-PCS — coders must verify placement site in the operative report
- Medtronic Micra AV2 and VR2 procedures group to MDC 5 and accurate site coding directly impacts DRG assignment
Overview
Leadless pacemaker technology continues to evolve rapidly, and hospital coders must keep pace with both the devices and the ICD-10-PCS codes used to report them. The Medtronic Micra AV2 and Micra VR2 are two of the most frequently implanted leadless cardiac devices in the inpatient setting today. Understanding their distinct clinical functions, correct procedure code selection, and new coding updates effective April 1, 2026, is essential for accurate claim submission and optimal DRG assignment.
What Are the Micra AV2 and VR2?
The Medtronic Micra AV2 is a leadless, single-chamber pacing device implanted directly into the right ventricle. Despite its single-chamber design, the Micra AV2 provides dual-chamber sensing with atrioventricular (AV) synchrony. It does this by detecting atrial mechanical activity through an accelerometer, then timing ventricular pacing accordingly — all without a lead crossing into the atrium. Clinicians often select the Micra AV2 pacemaker for patients who require AV synchrony but are not candidates for traditional transvenous systems.
The Micra VR2 is also a leadless, single-chamber pacemaker implanted in the right ventricle. Unlike the AV2, it provides ventricular rate-responsive pacing only, without AV synchrony. It is appropriate for patients with chronic atrial fibrillation or other conditions where AV synchrony is not a clinical priority.
Both devices are implanted percutaneously, typically via femoral vein access, and anchored to the myocardium using tines or a fixation helix. Because neither device uses traditional leads or a subcutaneous pulse generator pocket, they are classified under the intracardiac pacemaker (leadless) device value in ICD-10-PCS.
ICD-10-PCS Coding: What Code Do You Assign?
When selecting the correct ICD-10-PCS code, the key variables are the body part (where the device is anchored) and the device value (N = Intracardiac Pacemaker). The root operation is Insertion, and the approach is Percutaneous (3).
Code Table: Leadless Pacemaker Insertion
| ICD-10-PCS Code | Description | Effective |
|---|---|---|
| **02HK3NZ** | Insertion of Intracardiac Pacemaker into Right Ventricle, Percutaneous Approach | Current |
| **02HM3NZ** | Insertion of Intracardiac Pacemaker into Ventricular Septum, Percutaneous Approach | **New: April 1, 2026** |
> Device Value N = Intracardiac Pacemaker (leadless). This value applies to both the Micra AV2 and the Micra VR2, as ICD-10-PCS does not currently distinguish between single-chamber pacing only and dual-chamber sensing/single-chamber pacing at the device value level.
Prior to April 1, 2026, only Right Ventricle (body part K) was available for leadless pacemaker insertion coding. The addition of body part M (Ventricular Septum) reflects real-world implantation practices where physicians anchor the device to the interventricular septum rather than the free wall of the right ventricle.
Coders must review the operative report carefully to confirm the exact anatomical placement site. Do not default to the right ventricle code without documentation support. If the report is ambiguous, a clarification query is appropriate.
Documentation Requirements
To code these procedures accurately, the operative report should clearly document:
- Device name and manufacturer (e.g., Medtronic Micra AV2 or VR2)
- Implantation site — specifically whether the device was anchored in the right ventricle or the ventricular septum
- Percutaneous approach and access site (typically femoral vein)
- Final device position confirmed by imaging or fluoroscopy
Without documentation of the specific anchoring site, coders cannot confidently distinguish between 02HK3NZ and 02HM3NZ for procedures performed on or after April 1, 2026.
MS-DRG Impact
Leadless pacemaker insertions group to MDC 5, Diseases of the Circulatory System. Accurate procedure coding ensures appropriate DRG assignment and reflects the true complexity of the encounter.
Key Takeaways
- The Micra AV2 offers dual-chamber sensing with AV synchrony; the Micra VR2 provides ventricular rate response only — both are leadless, single-chamber pacing devices implanted in the right heart
- Both devices are coded using device value N (Intracardiac Pacemaker) in ICD-10-PCS
- 02HK3NZ remains the correct ICD-10-PCS code for right ventricle placement
- 02HM3NZ is a new code effective April 1, 2026 for ventricular septum placement — coders must confirm the site in the operative report
- Do not assign the ventricular septum code without clear documentation support; query when the implant site is ambiguous
- These procedures group to MDC 5 for MS-DRG purposes
- Proactive CDI education with electrophysiology teams will reduce query burden and improve first-pass accuracy
Tracy Blevins, MSHIM, RHIA
Senior Consultant, Audit
Tracy Blevins is a Senior Consultant in Quality Auditing at UASI, with 14+ years of inpatient medical coding and health information management experience. As a Registered Health Information Administrator that also holds AHIMA’s Auditing Inpatient Coding Microcredential, she shares practical, detail-driven coding tips to help clinicians and coders strengthen documentation, accuracy, and compliance.
Works Cited
Centers for Medicare & Medicaid Services. (2025). *ICD-10-PCS Official Coding Guidelines FY2026.* Available at: https://www.cms.gov/files/document/2026-official-icd-10-pcs-coding-guidelines.pdf
Medtronic. (2026, April). Coding guide. Available at: https://www.medtronic.com/content/dam/medtronic-wide/public/united-states/customer-support-services/reimbursement/coding-reference-guide-cross.pdf
FAQs
What is the ICD-10 code for pacemaker insertion when the Micra is placed in the right ventricle?
Use 02HK3NZ — Insertion of Intracardiac Pacemaker into Right Ventricle, Percutaneous Approach. This is the standard code for both the Micra AV2 and VR2 when anchored in the right ventricular free wall, and it has been in use prior to the April 2026 update.
What is the new April 2026 code for Micra placement in the ventricular septum?
02HM3NZ — Insertion of Intracardiac Pacemaker into Ventricular Septum, Percutaneous Approach — became effective April 1, 2026. Coders must confirm the placement site in the operative report before assigning this code; do not default to it without explicit documentation.
Does ICD-10-PCS distinguish between the Micra AV2 and VR2 at the code level?
No. Both devices use device value N (Intracardiac Pacemaker). The code selection is driven by the body part (right ventricle vs. ventricular septum), not by which Micra model was used. The clinical distinction between the AV2 and VR2 is relevant for quality reporting and charge capture but does not change the ICD-10-PCS code assignment.
What should I do if the operative report does not specify the exact implant site?
If the report documents only "right heart" or "ventricular" without specifying right ventricle versus ventricular septum, contact the coding or CDI team to request clarification from the electrophysiologist before assigning 02HM3NZ.
