# Upgrade of dual-chamber ICD to biventricular ICD.



## calorom2 (Oct 10, 2017)

I have never coded one of these...can someone give me some input/guidance?

Thank you!

PROCEDURE PERFORMED: 
Upgrade of dual-chamber ICD to biventricular ICD. 

PREOPERATIVE DIAGNOSIS: 
Chronic systolic heart failure.  Chronic RV pacing.  Ejection fraction 
less than 30%. 

ANESTHESIA: 
General. 

ESTIMATED BLOOD LOSS: 
None. 

UNANTICIPATED EVENTS/COMPLICATIONS: 
None. 

APPROACH: 
Upper left chest. 

DESCRIPTION OF PROCEDURE: 
The patient was brought to the operating suite, where the upper left 
chest area was prepped and draped in usual sterile fashion.  Adequate 
general anesthesia was obtained by the Anesthesia Department.  Venography 
was performed, which does not completely ensure patency of the left 
subclavian vein.  In fact, I think there is a large collateral there. 
We were successful in accessing this large collateral and then after 
dilating up this area and manipulating it past with various wires gaining 
access to the right heart, eventually a coronary sinus guide was introduced, 
and with great difficulty an inferior lateral wall vein was chosen and 
the St. Jude biventricular LV lead placed out.  The left lateral wall 
thresholds measured and found to be acceptable.  Leads connected to 
the new St. Jude biventricular ICD.  The deep tissue checked for dryness 
and closed with 3-0 Vicryl.  Skin was closed with 4-0 Monocryl in a 
running, 
subcuticular fashion.  Pressure was applied.  The patient sent to recovery 
room in stable condition.


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## CodeProAl (Oct 10, 2017)

*upgrade of ICD to biventricular system*

Look at the two codes below...

33225 for insertion of coronary venous lead and 
33263 OR 33264 for replacement of the generator.

You should choose between the 33263 and 33264 based on the # of final existing lead(s). For example, if the physician replaces the generator for dual lead system (right atrium and right ventricle) with a biventricular generator and adds a coronary venous lead, you should select 33264 for the generator replacement since the patient would now have leads in 3 chambers. 

Revision of the skin pocket at the time of the upgrade is not coded separately unless it involves I&D and drainage of a hematoma or complex wound infection, in which case a code from the Integumentary part of the CPT book could be added.  Also, CPT guidelines state that pocket relocation at the time of generator replacement can be reported separately with code 33223.

I hope this helps you!!


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## calorom2 (Oct 13, 2017)

Thank you!!


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