# Repositioning of ICD Gen and Leads



## jtuominen (Jun 16, 2009)

Wondering how others may code this situation--

Patient needs his existing ICD system moved from the right to left side of his body in order to receive radiation therapy for lung cancer. The existing ICD is removed, along with his RA and RV lead. A new pocket is made and the devices are then reinserted on the other side of the patients body. No new devices are implanted.

Would code this to 33249? or 33215/33223 even though there is a CCI edit? Or 33999? Any other ideas? Help!


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## bkiesecker (Jun 17, 2009)

i would probally bill 33241 for taking the generator out and then if you are sure they took the leads out and not just capped them and left them there,

 then bill 33244 for removal of both leads and then i would bill for 33249. the doctor is doing all the work and he can bill all of this as long as the documentation is there. 

hope this helps


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## jtuominen (Jun 17, 2009)

Thanks, I agree with your codeset, but since I am a facility side coder I bet this will get denied anyway since I will not have the matching HCPCS device codes. We'll see what happens!


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## wspanic (Jun 18, 2009)

You will get denied if this is Medicare. Medicare has the procedure to device edit. I would check with your Insurance Contract or call the Insurance Company just to make sure you do not get reimbursed for the device again as this would be inappropriate. Your codes are right. 33241, 33244, 33249


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## jtuominen (Jun 19, 2009)

wow. thanks for that tip. I didn't even think about that. I will check into their insurance carrier. Our processes are so compartmentalized where I work I am not involved in any of claim submission or denial process after I code cases, so that wouldnt have even crossed my mind. I am still new at facility coding, so Thanks!


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## jtuominen (Jun 24, 2009)

As a follow up I ended up contacting the patients insurance company (BCBS) and they recommended that the unlisted procedure code be billed instead of the codeset detailed above. 33999 with report.


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