# Caridology Practical Question



## jleible (Apr 4, 2013)

*Cardiology Practical Question*

Can someone please help me I have a Practical question. 

Insertion of left ventricular epicardial pacemaker lead with generator change.
i coded 33202, 33225-51 is this correct.

Also Dx codes for:  Ischemic cardiomyopathy, Intraventricular conduction delay. Congestive Heart failure.  
i coded 414.8, 426.9 and 428.0

Thank you


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## RhondaJohnson (Apr 4, 2013)

Is this patient "upgrading" a dual chamber pacemaker to an AICD?  In that case the codes will depend on whether the existing pacemaker is a single lead or dual lead system.


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## jleible (Apr 4, 2013)

the generator was upgraded from a dual pacemaker pacing cardioverter def, because left ventricular pacing was added.


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## RhondaJohnson (Apr 4, 2013)

I'm thinking 33202 (epicardial lead), 33230-51 (insertion of cardio def generator), 33233-51 (removal of the permanent pacemaker pulse generator).


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## jleible (Apr 4, 2013)

thank you so much for your help


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## Twixle2002 (Apr 5, 2013)

I believe you would use 33225 because the cpt book says "Insertion of pacing electrode, cardiac venous system, for left ventricular pacing at the time of insertion of pacing cardio-defibrillator or pacemaker pulse generator", since the patient is upgrading.


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## jleible (Apr 5, 2013)

thank you so much and yes i went with 33225


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## Misty Dawn (Apr 10, 2013)

I know you already went with 33225 but if it truly was a "epicardial" LV insertion the code is 33202. 

 A good free reference I use is the AMA demo reference guide at http://www.cenveomobile.com/i/27249/59.  The below is taken from there regarding epicardial LV lead placement.  

"The electrodes (leads) of a pacing cardiovert-defibrillator system are positioned in the 
heart via the venous system (transvenously) in most circumstances. In certain circumstances, an additional electrode may be required to achieve pacing of the left ventricle (bi-ventricular pacing). In this event, transvenous (cardiac vein) placement of the electrode should be separately reported using code 33224 or code 33225. Epicardial placement of the electrode should be reported using code 33202 or code 33203."


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