# code a single icd to biventricular



## OPENSHAW (Feb 13, 2013)

Patient is have a single icd removed and replaced with biventricular which is more than two leads.  How would you code this?

33241
33249
33225

Thank you!


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## jbhansen (Feb 13, 2013)

It depends.  If the only new lead being inserted is the LV lead then you would code 33263 and 33225.
CPT 2013 added to the table (p. 177 professional edition) "Conversion of existing system to bi-ventricular system (addition of LV lead and removal of current generator with insertion of new pulse generator with bi-ventricular pacing capabilities 33225 + 33228 or 33229 (pacemaker) 33225+33263 or 33264 (ICD)"
If a new lead is being inserted in either the RA or RV in addition to the new LV lead then you would code as you have indicated.


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## EmilyDingee (Feb 13, 2013)

For an single to BIV-ICD upgrade I code 33249,33225,33241 and 93641 (if testing)

33263 is for generator change not upgrades, there I do not agree with this.


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## theresa.dix@tennova.com (Feb 14, 2013)

EmilyDingee said:


> For an single to BIV-ICD upgrade I code 33249,33225,33241 and 93641 (if testing)
> 
> 33263 is for generator change not upgrades, there I do not agree with this.



 You cannot go by what the description of the procedure says "upgrade" I have seen this used and its not an upgrade. Read the report. If a LV lead is implanted at the time of a generator change -

Report the new generator change codes  Defib 33262-33264 AND 33225.

The only time you would use the 33249 is if a new RA or RV lead was implanted.


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