Pacemaker Electrode Lead Replacement - help with Procedure Codes

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I need some help figuring out how to code for electrode replacement on a pacemaker. This is the scenario I'm trying to decipher: Procedure is an epicardial electrode replacement; both the atrial and ventricular leads are replaced.

It's my understanding that you don't code for the removal, only the insertion. I've read the guidelines over and over and I still can't figure it out. I think my problem lies in the fact that there's no indication of whether the pacemaker is temporary or permanent...?
 

CodingKing

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I can find insertion of epicardial electrodes 33202 (open) or 33203 (Endoscopic).

I can find the removal of epicardial system w/ electrodes 33236 (Single) 33237 (Dual). My plain language code book says not to report this code unless pulse generator is being removed as well.

I can not find a code for removal of Epicardial electrodes only. All the other removal codes I see are for transvenous. Epicardial is much more complicated than transvenous as they cant just pull them out. They are placed directly on the heart .Maybe it truly is bundled with the placement codes?
 
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I couldn't find code for replacement or removal of epicardial electrode, so insertion of epicardial electrode must have removal of any existing electrode as well.
 
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can you paste the notes minus patient information of course

See, that's the problem... I have no other information except:
"Procedure is an epicardial electrode replacement for pacemaker; both the atrial and ventricular leads are replaced."

So far I've been told that only ONE code should be billed so I took a shot in the dark and said 33217 but apparently that's not right. I have NO idea. I just don't see how coding this with only ONE code would be possible. :confused:
 

CodingKing

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33217 wont work as that is transvenous.

Epicardial is placed directly on the heart by either open procedure (thoracotomy, median sternotomy, subxiphoid approach) or Endoscopic (thoracoscopy, pericardioscopy etc). You don't have enough info to even assign an insertion code. There is no code for removal unless the pulse generator is also being removed.
 
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