Cardiology Coding Alert

You Be the Coder:

Puzzle Out This Pulse Generator Removal Situation

Question: My provider made an incision on the patient’s skin over the subcutaneous pocket, enclosing the existing generator. They freed the existing generator from the fibrous adhesions surrounding it and also separated the leads from the fibrous adhesions in the pocket. My provider then tested the existing leads for proper functioning. Next, they adapted the existing skin pocket to the dimensions of the new multiple lead system generator. My provider cleaned the pocket by irrigating it with saline. They placed the new generator into the pocket and attached it to the existing leads. Finally, my provider closed the skin pocket with sutures. They programmed the device for optimal functioning. Which code should I report on my claim?

South Carolina Subscriber

Answer: You should report 33264 (Removal of implantable defibrillator pulse generator with replacement of implantable defibrillator pulse generator; multiple lead system) on your claim.

Tip: You would report 33264 when your provider both removes and replaces a pulse generator for a multiple-lead implantable defibrillator. Code 33264 is specific to multiple lead systems, which means the implantable defibrillator functions in at least three cardiac chambers.

You can report defibrillator threshold testing (DFT) your cardiologist performs during the defibrillator insertion or replacement separately with 93640 (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) or 93641 (… with testing of single or dual chamber pacing cardioverter-defibrillator pulse generator).

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