Cardiology Coding Alert

Question: A patient who has a previous biventricular implantable cardiac defibrillator undergoes a new ICD implantation. The cardiologist finds that the right atrium (RA) and right ventricle (RV) leads are properly functioning and attaches them to a new ICD generator. And the cardiologist implants a left ventricular (LV) lead. Should I use 33249 or 33240 for the implant of the generator with 33225 for the LV lead and 33241 for the removal of the previous generator?

Massachusetts Subscriber

Answer: You should use 33240 (Insertion of single or dual chamber pacing cardioverter-defibrillator pulse generator), 33241 (Subcutaneous removal of single or dual chamber pacing cardioverter-defibrillator pulse generator), and +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] [list separately in addition to code for primary procedure]).
 
Code 33225 is an add-on code to 33240 as well as 33249 (Insertion or repositioning of electrode lead[s] for single or dual chamber pacing cardioverter-defibrillator and insertion of pulse generator), which includes one or more electrodes. In this case, the cardiologist leaves both the RA and RV leads in place and reconnected to the generator.
 
Also, if you have the appropriate documentation, make sure to bill for fluoroscopy (71090-26, Insertion pacemaker, fluoroscopy and radiography, radiological supervision and interpretation; professional component) as well as the electrophysiologic test of the defibrillator (93641, Electrophysiologic evaluation of single or dual chamber pacing cardioverter-defibrillator leads including defibrillation threshold evaluation [induction of arrhythmia, evaluation of sensing and pacing for arrhythmia termination] at time of initial implantation or replacement; with testing of  single or dual chamber pacing cardioverter-defibrillator pulse generator).
 
Cardiologists commonly perform these procedures at the same time as an ICD generator implantation.