# Rv lead extraction & implant biv upgrade



## kproctor (May 13, 2009)

hello, 
I'm having a problem coding  the above, any help would be greatly appreciated..
thanks, 
Kelly Proctor, CPC


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## deeva456 (May 13, 2009)

What is your question and do you have the report?


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## kproctor (May 14, 2009)

Hello, 
Thanks for answering, I do have the report, and the procedure is RV Lead extraction and Implant of BIV upgrade..It looks like he had an AICD, and is being upgraded.  
thanks,
Kelly


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## deeva456 (May 14, 2009)

W/O looking at the report it is hard to help you with the codes. Was the lead removed and not capped? when replacing the ICD unit how many leads were inserted? Did the doctor remove the generator or previous device? was fluoroscopy guideance indicated?  Was DFT performed after the ICD insertion or the next day? What is the reason for replacing the ICD, battery depletion or other causes.  All these components can be coded if supported in the report. 

Dolores, CPC, CCC


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## kproctor (May 15, 2009)

hi dolores, 
Ok, Brief rundown, 
the pulse generator was removed, and old leads were disconnected.
The chronic RV lead was extracted, attention was then turned to the new RV 
lead. the lead was placed into the right ventricular apex under fluoroscopic guidance.
The generator was inserted into the pocker. Only one lead is ever mentioned in the Op report..
Defiibrillation testing was done..
I know the 71090-26, and a Biv code 33224 or 33225??
But i'm not sure of the others..thanks, kelly


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## deeva456 (May 15, 2009)

kproctor said:


> hi dolores,
> Ok, Brief rundown,
> the pulse generator was removed, and old leads were disconnected.
> The chronic RV lead was extracted, attention was then turned to the new RV
> ...





Ok, based on what you wrote, here are the codes:

33249 -insertion or repositioning of electrode leads - single/dual chamber ICD and pulse generator. 
33241 - subcutaneous removal of single/dual chamber pacing ICD pulse generator  (assuming removal was done this way)
33244 - removal of single/dual chamber ICD lead(s) by transvenous extraction
71090-26 - fluoroscopy 
93641-26 - DFT testing ( if done after the ICD implant)

You would not bill 33224 or 33225 because this is for the left ventricle.

Good luck!

Dolores


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## kproctor (May 18, 2009)

Thanks so much,
Kelly


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## gsweet@umc.edu (Apr 4, 2014)

*33244-Cardiology*

We have a CPT code 33244 for "Removal of single or dual chamber pacing cardioverter-defibrillator electrode(s); by transvenous extraction ". What code is needed for removal of additional lead from rt ventricle. The pt has 3 leads removed (1 in right atrium and 2 in right ventricle) coded 33244 for two leads.  What should be coded for the third lead removal. 

Thanks


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