# Upgrade from dual PPM to Bi-V PPM code



## camsgram (Apr 12, 2012)

Can anyone help with correct code.  Is cpt 33224 considered an upgrade from dual to bi-v? It states that it also includes replacement of existing generator.  Is there another code that should be used with this??

Any help would be greatly appreciated!


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## twizzle (Apr 12, 2012)

*Pacer upgrade to Bi-V*



camsgram said:


> Can anyone help with correct code.  Is cpt 33224 considered an upgrade from dual to bi-v? It states that it also includes replacement of existing generator.  Is there another code that should be used with this??
> 
> Any help would be greatly appreciated!



Are they upgrading the generator as well? In all probability they are so you would code for generator change 33229 and 33225 for placement of the LV lead.
If all they are doing is utilizing the existing generator and adding a LV lead then 33224 is appropriate. This includes removal and reinsertion of the existing generator.
Hope this answers your question.


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## camsgram (Apr 13, 2012)

Wassock~Guru
Thanks so much for your reply.  That definitely makes better sense.  There has been so many updates with pacers/icds that this case was confusing.  THANKS again for your expertise!


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## twizzle (Apr 13, 2012)

*BI-V upgrade*

Pleased to have helped.
Some of the new codes have not been properly thought through by the 'experts'.


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## Robbin109 (Apr 22, 2012)

It  looks like 33224 includes removal, insertion, and/or replacement of existing generator, so wouldn't you code 33224 in either case...sorry...these new codes are so confusing...????


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## twizzle (Apr 22, 2012)

*Bi-V upgrade*



Robbin109 said:


> It  looks like 33224 includes removal, insertion, and/or replacement of existing generator, so wouldn't you code 33224 in either case...sorry...these new codes are so confusing...????


33224 is purely for use when a LV lead is being added to an existing system. When it says 'including removal, replacement etc.' it does not mean the generator is a new one. It means the existing generator may be taken out while the LV lead is being placed and then that same existing generator is put back in the pocket and all the leads are then reconnected to that same original generator. The descriptors are somewhat confusing and can be interpreted incorrectly because of the poor wording. Replacement of an existing generator means taking out the old generator and putting in a new one... 33262-33264 for ICDs or 33227-33229 for pacemakers.


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## Robbin109 (Apr 22, 2012)

Thanks for clearing that up! Makes sense.


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## Robbin109 (May 2, 2012)

Can someone tell me the 2011 (old codes) for this procedure?

Upgrade from dual ppm to bi-v ppm with gen change?

Thanks!


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