# Pulse generator replacement



## espressoguy (Aug 27, 2015)

I haven't come across this before and suddenly I have 2 on the same day. Provider removes an ICD pulse generator and replaces it with a pacemaker pulse generator using the existing leads.

Would this be 33227, 33228, or 33229 as the end result is the patient has a pacemaker or would this be something else?

Thanks.


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## mholtzhouser (Aug 28, 2015)

How many leads?  Left/Right atrial/ventricle

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Michele CPC, CCC


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## espressoguy (Aug 28, 2015)

In one case 3 and the other 2. 

The problem is that the remove and replace codes don't really address removing one type of generator and replacing with a different type of generator. Right now I'm leaning towards using 33241 for the ICD removal and using 33208 for the pacemaker as it includes replacement, not just new (which I didn't know since this is the first time I've come across this scenario).


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## mholtzhouser (Aug 28, 2015)

I would use 33241 for the ICD removal and then 33213 for the pacemaker generator insertion with dual leads.  On the one with three leads, did they cap one or using all three?

Michele CPC, CCC


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## espressoguy (Aug 28, 2015)

They used all 3.

Thanks for your help on this.


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## twizzle (Aug 28, 2015)

espressoguy said:


> They used all 3.
> 
> Thanks for your help on this.



Two leads 33241, 33213. Three leads(assuming all were attached to the generator), 33241, 33221.


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