# Dual ICD upgrade to Bi-V ICD w/new lead



## HEMINGWAYT (Aug 27, 2013)

Hi,
Can I get some help with this situation:

Existing dual chamber ICD is explanted, the atrial lead is capped due to dysfunction.  A new atrial lead is implanted, a new LV lead is implanted and a new BI-V ICD generator is implanted and connected to all three leads.  We have coded 33241 for removal of ICD generator, 33249 for insertion of ICD w/lead single or dual chamber and 33225 for insertion of left ventricular lead.  Is this correct?

Thanks in advance,


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## geigert (Aug 28, 2013)

In this situation I belive your primary code should be 33264 for the removal of the old generator and the implantation of the new multiple lead system.  Then I agree you should use the +33225 for the insertion of the left ventricular lead.  I belive you could also then use code 33216 for the insertion of the new atrial lead.


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## twizzle (Aug 28, 2013)

HEMINGWAYT said:


> Hi,
> Can I get some help with this situation:
> 
> Existing dual chamber ICD is explanted, the atrial lead is capped due to dysfunction.  A new atrial lead is implanted, a new LV lead is implanted and a new BI-V ICD generator is implanted and connected to all three leads.  We have coded 33241 for removal of ICD generator, 33249 for insertion of ICD w/lead single or dual chamber and 33225 for insertion of left ventricular lead.  Is this correct?
> ...



You are correct. The other suggestion to use 33264 is not correct as a new atrial lead is placed, therefore 33249,33225,33241(and 93641-26 if testing was done).


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## HEMINGWAYT (Aug 28, 2013)

Thank you, I was looking for validation that you can't use the 33264 unless you are using ALL existing leads.


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