Note CPT® Specifications for ICD Generator Replacement
Question: Do I need an add-on code to report an upgrade of a single chamber pacemaker to a cardiac resynchronization therapy with defibrillator (CRT-D)? New Mexico Subscriber Answer: Yes, you’d need an add-on code when reporting a procedure “upgrading” a single-chamber pacemaker to a cardiac resynchronization therapy with defibrillator CRT-D device, according to Jayna Tuominen, RHIA, CPC, CCVTC, CIRCC, CCC, who addressed such a situation in her presentation “Cardiac Rhythm Management Surgical Procedures” at HEALTHCON 2025. “If you’re doing a generator change out, with the addition of a left ventricle [LV] lead via coronary sinus, then you’re essentially upgrading the system,” she explained. You can use the code range 33262-33264 (Removal of implantable defibrillator pulse generator with replacement of implantable defibrillator pulse generator; single lead system; … dual lead system; … multiple lead system) with add-on code +33225 (Insertion of pacing electrode, cardiac venous system, for left ventricular pacing, at time of insertion of implantable defibrillator or pacemaker pulse generator (eg, for upgrade to dual chamber system) (List separately in addition to code for primary procedure)) for this service. These codes would be appropriate when reporting an implantable cardioverter defibrillator (ICD) generator replacement without any manipulation of leads — the process involves just connecting them to a new generator, she said. And remember, according to the CPT® 2025 guidelines, “code choice for the generator change is based on the number of final existing lead(s),” which conflicts with instructions provided in the December 2013 CPT® Assistant, Tuominen noted. Rachel Dorrell, MA, MS, CPC-A, CPPM, Development Editor, AAPC
