Cardiology Coding Alert

Question: How should I code the following case? The cardiologist removed two ICD leads and then placed two new leads (one in the right ventricle, one in the left). This was done transvenously under fluoro. The device (pulse generator) was removed prior to lead extraction, and the same generator was put back in place at the end. After the system was in place, the cardiologist performed an electrophysiologic study to determine adequacy of defibrillation thresholds. He induced ventricular fibrillation and successfully cardioverted the patient.

California Subscriber

Answer: Because the cardiologist did not insert a new pulse generator, you should code the lead extraction, lead insertion, and electrophysiologic (EP) study. You should not code for insertion and replacement of the existing pulse generator.

For the extraction, report 33244 (Removal of single or dual chamber pacing cardioverter-defibrillator electrode[s]; by transvenous extraction). The appropriate code for lead insertion is 33217 (Insertion of 2 transvenous electrodes, permanent pacemaker or cardioverter-defibrillator). You should not report the fluoro separately.

The cardiologist tests both the leads and the pulse generator, so you should report 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). Remember to append modifier 26 (Professional component) to 93641.