# Upgrade of dual-chamber perm ICD to biventricular icd



## amym (May 2, 2013)

Please help me code this!

A sterile preparation of the right groin and a 8-French sheath was introduced into the right femoral vein, and using a ---- steerable octapolar catheter, location of the coronary sinus was marked.  After the sterile preparation of the skin surrounding the previous defibrillator implant in the left deltopectoral area with antiseptic scrub, this area was carefully covered with a Steri-Drape followed by the application of sterile towels and a split laparotomy sheet.
Then 0.25% Marcaine was administered into the area of the previously performed defibrillator pocket for local anesthesia.  An incision was made over the previous incisional site, and using sharp and blunt dissection, the defibrillator pocket was explored, and the leas were then carefully dissected to their insertion into the defibrillator header.  The device was then removed from the ICD pocket, and the leads were carefully separated from the device with an appropriate wrench.
At this point, under the guide of fluoroscopy and a left upper extremity venogram, the left axillary vein was accessed, and a 9-French sheath was introduced.  Using a long coronary sinus sheath over a Glidewire, the coronary sinus was cannulated, and a selective venogram was performed through a balloon tipped catheter.  Using a subselect coronary sinus catheter, a new LV lead was placed into the high lateral coronary sinus branch with good pace sense parameters. 
Patient lead parameters were measured for the following:
1.	RV Lead, Right atrial lead and the new LV lead
The new lead was secured to the underlying pectoral fascia with 0 Ethibond sutures.  At this point, the leads were then inserted into the appropriate posts of the new defibrillator device, with particular attention so that the terminal pins were aligned correctly into the header and the set screws were then tightened, and the leads were then inserted into the previously performed ICD pocket, and proper device function was confirmed.  The pocket was irrigated with antibiotic solution, and then the subcutaneous tissue was closed with absorbable suture, and skin was closed with continuous absorbable suture.  
A sterile occlusive dressing was applied and compression dressing was applied on top of that.


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## Misty Dawn (May 2, 2013)

Removal of current generator with insertion of new generator w/ BiV pacing capabilites= 33264
Additon of LV lead= 33225


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## HEMINGWAYT (May 3, 2013)

I'm confused as to why guidelines are telling us if we remove a dual ICD and replace with a multi lead ICD to use 33264.

Under the 33262-33264 descriptions in CPT, shouldn't the explant device match the implant device?


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## Misty Dawn (May 3, 2013)

Hi  I am not sure what your are asking?  In my Heart Rythm society coding guide it states that you code for what was implanted not taking out.    For example if you used the dual lead gen change code for the patient below then it would look like the pt has a dual lead ICD when the pt actually has a BiV (or multi lead) ICD implanted.  I think it is to correctly show what type of device the patient currently has implanted but that is just my thought.  

HTH,  Misty


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