Wiki Coding a LBB lead

[S Smith]

I was wondering if anyone has physicians that have been implanting LBB leads? Our physicians have been inserting LBB leads now instead of the usual RV lead. The lead goes through the septum from the right side and is screwed into the left bundle area. They use it for LV pacing. However, while discussing the code with the physician he pointed out that while they are using it for LV pacing, it is not going into the cardiac venous system which the code 33225 states. While I believe when only an atrial lead and a LBB lead is inserted we would use the dual chamber code 33208. When they are inserting three (atrial, Right ventricle and LBB) leads, I was wondering if it would be appropriate to code 33999 for the LBB lead?

 

[Misty Dawn]

33208 would be used for for RA, RV and LBB. CPT codes 33206, 33207 and 33208 code definition notes " transvenous electrode(s)". So this means for example if you have two leads in the atrial would be coded with 33206.

 

[nanalita]

I have physicians implanting a third lead for LV pacing with an ICD. An LV lead placement through the CS was unsuccessful so the third lead went to the HIS bundle. I was audited and told I must bill 33225 with the 33249 in order to code for that third lead even though it was not able to be placed into the cardiac venous system. This lead is for LV pacing but I don't think it qualifies for the 33225 code as the approach is not in the description for that code. I think this third lead is included in the 33249 code or possibly with the 33999 unlisted code. Any thoughts? Right or wrong?

 

[camillecoder@hotmail.com]

33225 is not correct because the lead is NOT in the LV/coronary sinus. If you have access to Z Health Publishing, see question ID 15259. 33249 does state lead or leads.