# Coding  PM upgrade  to ICD w/ LV lead



## deeva456 (Oct 18, 2017)

I need a 2nd opinion on how to code upgrading a pacemaker to ICD generator with an LV lead. 

The physician billed for removal of the pacemaker generator, RV lead  and LV lead insertion.  The codes he selected are: 33233, 33216 and 33224.  The codes I selected are: 33233 - PM generator removal, 33249 ICD implant, single or dual lead and 33225 - LV lead.  The physician explained that he was taught to use 33233, 33216 & 33224.   In what scenario is 33224 billed?  I use Dr. Z's Medical coding reference for cardiology but it does not give any information how to use this code. 

Thank you for your help.

Dolores


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## twizzle (Oct 18, 2017)

*PM upgrade to ICD with LV lead.*

You are completely correct in your code assignment and your provider, despite being obviously very intelligent, is like a lot of providers.....they think they are expert coders. I wonder who told them to use those codes.

33249, 33225, 33233 are correct.

33224 is for insertion of an LV lead to a previously placed pacer or ICD generator. In coding EP for 5 years I don't think I ever used the code. You will probably never use it either.


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