# icd generator replacement



## kimberlybaggott@gmail.com (Jan 21, 2013)

PROCEDURE:
patient was taken to the cardiac cath lab and prepped and draped in the usual sterile fashion.  fluoroscopy was used to examine current lead placement.  1% Xylocaine with epinephrine was used to anesthetize the skin overlying the left intraclavicular area over the existing generator.  an incision was then made over the existing generator and blunt dissection was used to obtain the generator and lead.  the generator was removed from the lead and the lead was tested and found to have the appropriate thresholds.  a new single chamber, rate responsive icd was connect to the lead and the pocket was then vigorously irrigated with antibiotic solution.  the generator and lead were coiled and placed in pocket.  the poket was then closed.

the codes I want to use are:
33262 -- replacement of generator
76000-26 --fluoroscopy
93640 -- testing of leads

could someone tell me if this is correct or do I use 33262 only


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## swethathulasi (Jan 21, 2013)

I guess what you have coded is correct.


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## Cyndi113 (Jan 22, 2013)

Your code should be 33262. 93640 is an EP study code.


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## j.monday7814 (Jan 22, 2013)

usually the leads and pulse generator are tested during an initial implant or during replacement. so depending on whats done 93640-93642 may be appropriate. I wouldn't bill the 93640 with the report you submitted because there aren't any values documented. If the doc mentioned the threshold values and impedance values then 93640 would be supported. And DFTs are usually done too (defibrillation threshold testing).....are you sure this is all of the documentation for this generator change?


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## theresa.dix@tennova.com (Jan 23, 2013)

jeremym@pimaheart.com said:


> usually the leads and pulse generator are tested during an initial implant or during replacement. so depending on whats done 93640-93642 may be appropriate. I wouldn't bill the 93640 with the report you submitted because there aren't any values documented. If the doc mentioned the threshold values and impedance values then 93640 would be supported. And DFTs are usually done too (defibrillation threshold testing).....are you sure this is all of the documentation for this generator change?



Yea simple testing of the leads is not separately billable but Dft testing is. Look for something with wording "Joules". We usually have a different doc that performs dft's so there is a separate report. Maybe this is the case?


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## raycathey (Jan 23, 2013)

Only the generator change code - 33262 can be billed as of 1/1/13.  The fluoro is always included in any pacemaker or ICD procedures.  As of 1/1/13, the lead testing is also bundled into the procedure per NCCI as quoted from November issue of Part B News.


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## Amanedmaiston (Jan 30, 2013)

I would only code 33262 also.


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