Look to 33224, +33225 for LV Lead Implants
Question: We have a new cardiologist who provides left ventricular lead implants. How do I code these? Missouri Subscriber Answer: An LV lead is attached to a pacing ICD and achieves biventricular pacing, which can benefit patients with congestive heart failure. The key to proper left ventricular (LV) lead coding is to watch the documentation for whether the pacing device is new or previously placed. Already implanted: You should report 33224 (Insertion of pacing electrode, cardiac venous system, for left ventricular pacing, with attachment to previously placed pacemaker or pacing cardioverter-defibrillator pulse generator [including revision of pocket, removal, insertion, and/or replacement of generator]) if the cardiologist upgrades an already-implanted system to a biventricular device by adding a left ventricular lead. Keep an eye out for documentation of fluoroscopy (71090, Insertion pacemaker, fluoroscopy and radiography, radiological supervision and interpretation) because this is necessary to advance the lead. New: If the physician attaches an LV lead to a new system, you should report +33225 (Insertion of pacing electrode, cardiac venous system, for left ventricular pacing, at time of insertion of pacing cardioverter-defibrillator or pacemaker pulse generator [including upgrade to dual chamber system]) in addition to the main procedure code. For example, if the cardiologist inserts a single- or dual-chamber pacing cardioverter-defibrillator pulse generator, report both +33225 and 33240 (Insertion of single or dual chamber pacing cardioverter-defibrillator pulse generator) for the generator insertion.
