# Remove and Replace Pulse Generator



## OPENSHAW (Sep 4, 2013)

Our doctor Removed a Dual Lead Pulse Generator only and Replaced it with a Single Lead Pulse Generator!

Would this be coded as CPT Code 33227?
Any suggestions?

Op note states She was referred for cardiac catheterization to replace defective pacemaker, reaching end of life.  

Interventions:
Pacemaker revision and generator replacement.

Findings:Malfunctioning pacemajer

Thank you for your help!!!!!!


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## twizzle (Sep 4, 2013)

OPENSHAW said:


> Our doctor Removed a Dual Lead Pulse Generator only and Replaced it with a Single Lead Pulse Generator!
> 
> Would this be coded as CPT Code 33227?
> Any suggestions?
> ...



Is that the report?!


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## OPENSHAW (Sep 4, 2013)

*Remove and Replace Single Lead Generator*

She was referred for cardiac catheterization to replace defective pacemaker, reaching end of life.
Procedure Details
The risks, benefits, complications, treatment options, and expected outcomes were discussed with the patient. The patient and/or family concurred with the proposed plan, giving informed consent. Patient was brought to the cath lab after IV hydration was begun and oral premedication was given. She was further sedated with midazolam. She was prepped and draped in the usual manner. 
Interventions:
Pacemaker revision and generator replacement.
The left pectoral area was prepped in the usual fashion. The patient received 20 cc of lidocaine.
An incision was made on the previous scar in the anterior pectoral area. The area was carefully disseted until I reached the old pacemaker. It was then explanted and with a wrench the leads were disconeected and rapidly due to a lack of intrinsic rhtythm the new pacemaker was connected and the lead secured with a wrench. Capture was achieved.  The pacemaker was placed in the previous pocket and the area flushed with antibiotic solution. Thereafter the subcutaneous tissue was closed in layers using 2-0 Vycril. The skin was then stapled and the procedure terminated after a pressure dressing was applied.
The patient tolerated the procedure well there were No complications.

Findings:Malfunctioning pacemajer

Condition: stable


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## twizzle (Sep 4, 2013)

OPENSHAW said:


> She was referred for cardiac catheterization to replace defective pacemaker, reaching end of life.
> Procedure Details
> The risks, benefits, complications, treatment options, and expected outcomes were discussed with the patient. The patient and/or family concurred with the proposed plan, giving informed consent. Patient was brought to the cath lab after IV hydration was begun and oral premedication was given. She was further sedated with midazolam. She was prepped and draped in the usual manner.
> Interventions:
> ...



Report needs more information to code it. He says lead was secured but doesn't say which lead or what he did with any lead which would have been abandoned if only a single chamber pacer was implanted to replace a dual chamber.
I may be nit-picking but I don't code anything without all the information. Don't forget, if it's not documented...you know the saying. If it is dual removal and single chamber placement it would be 33227. Would anyone code it "as is"?


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