# Upgrade: Dual ICD to Biventricular



## jewlz0879 (Mar 25, 2011)

Can somone please provide some solid assistance here? We have a few coders who disagree with one another and I would like to some clarification, please. 

A patient has a dual lead pacemaker, but it needs to be upgraded to a biventricular. 

The old generator is removed, pocket revised, LV lead was placed into the target vessel. 

Then new biv- ICD was connected to the atrial, RV and LV leads, DFT testing performed. 


Coder ONE says: 33240, 33241, 33225 & 93641 - 26

Coder TWO says: 33224 & 93641 since pt has a previous ICD and 33224 includes pocket revision, removal, insertion of new generator. 

But then I saw someone on BOCN saying it should be 33249, 33225. 

PLEASE HELP! Can anyone explains this???


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## mariecass (Mar 27, 2011)

Did the Patient have a Pacemaker and then an upgrade to Bi-V ICD or a Dual ICD and upgraded to a Bi-V ICD?

If it was a dual pacemaker removed, LV lead inserted, new ICD generator, and DFT Testing: 33233, 33225, 33240, 93641-26, 71090-26.

If it was a ICD generator removed, LV lead inserted, new ICD generator, and DFT Testing: 33241, 33225, 33240, 93641-26, 71090-26.


33224 only is used when you don't replace the generator (you use the same exact generator)! 

33249 can't be billed because you didn't insert a new lead with a generator (a new right atrial lead and/or new right ventricular).


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