Wiki Remove/Replace Pulse Generator with lead repair

[tbelles]

Good Morning,
I need some advice on coding please
My doctor did a dual chamber pacemaker pulse generator removal and replacement.
He ended up capping off and replacing one of the old leads (ventricular) and reused the other (atrial).
How would you code that?
He used 33207 and 33233 but Blue Cross is saying "This should be billed with the appropriate codes for these services"
Am wondering if we need to add a 33234 for the removal of the lead, or maybe use the 33228 with a 33218 fir the lead repair?
Help!

 

[cpc2007]

Hello - is it possible for you to post the note without any patient information included - just the procedure details? There are a few details described that seem a little unusual and would impact coding. Normally when a lead is capped it's not replaced (it's just left in the body and not used). So I'm questioning if removal occurred or just insertion of a new ventricular lead. I'm also not seeing anything described that would support a lead repair (33218) offhand. If a lead was removed (not capped and left in place), and the original system was dual chamber, we would be at a 33235 not a 33234 for that removal. What happens with the leads will ultimately drive the final coding for the generator too (i.e., generator replacement vs. system replacement). So I think seeing the full note in context without PHI would help to better answer your question

Kim
www.codingmastery.com

 

[tbelles]

Hello - is it possible for you to post the note without any patient information included - just the procedure details? There are a few details described that seem a little unusual and would impact coding. Normally when a lead is capped it's not replaced (it's just left in the body and not used). So I'm questioning if removal occurred or just insertion of a new ventricular lead. I'm also not seeing anything described that would support a lead repair (33218) offhand. If a lead was removed (not capped and left in place), and the original system was dual chamber, we would be at a 33235 not a 33234 for that removal. What happens with the leads will ultimately drive the final coding for the generator too (i.e., generator replacement vs. system replacement). So I think seeing the full note in context without PHI would help to better answer your question

Kim
www.codingmastery.com

Hi
Thanks for the response...we are so conflicted on this Haha.
I will gladly post the note for you to look over. Any input you have would be greatly appreciated.

Thanks again!

Tricia