Wiki need help for LV lead extraction and new lv insertion with gen change cpt

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bhargavi

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the physician is doing Lv lead extraction and inserting new Lv lead with BIV ICD gen change I am not able to find code for Lv lead extraction should I code unlisted procedure?
I am coming up with
33264, 33244, 33225
thanks in advance
 
The descriptor for CPT 33244 doesn't specify where the leads are removed from (LV, RV, RA), only that it is by transvenous extraction so it is the correct code for removal of the LV lead. Not necessary to use an unlisted code here.
Agree with your other codes as well.
Don't forget any defibrillator threshold evaluation if performed. When I coded EP my providers nearly always did 93641-26 at the time of ICD placement/exchange unless there was a good (medical) reason not to do it.
 
Previously, that is the way I would have coded this procedure; however when reading cpt asst article for another issue I saw this statement below. Does that mean coding would be 33249, 33225 and 33244?

June 2012 CPT Asst article - last page - "* If both a pulse generator and one to three electrode(s) are inserted or replaced, report the appropriate system code".

Thanks in advance for the help!
 
I would code this 33244 for the removal of the lead, and 33249 for the ICD w/ lead. I would not code 33225 because there was a previous lead and 33225 is for when the original ICD is placed (so all three leads are placed at the same time) or when the generator is being placed and the doctor decides to upgrade the ICD and adds the LV lead.

HTH,
Jim Pawloski, CIRCC
 
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