# upgrade from single chamber ICD to dual chamber ICD



## denisek1028 (Jun 10, 2016)

Just need to confirm that I am correct. My provider removed a single chamber ICD and inserted a dual chamber ICD and also a new lead.  Would we use the combined removal and replace code of 33263?  Would we also bill for the addition of the new lead?

Thank you!

Denise


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## Casper204 (Jun 10, 2016)

I work for an EP group and see this kind of case a lot.  You can't code 33263 with 33216.  Because he added a lead it would be coded 33249 and 33241-51.  33249 covers the insertion of the new generator and the addition of the lead and 33241 covers the removal.  

Cristine Ward, CPC


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## twizzle (Jun 11, 2016)

Casper204 said:


> I work for an EP group and see this kind of case a lot.  You can't code 33263 with 33216.  Because he added a lead it would be coded 33249 and 33241-51.  33249 covers the insertion of the new generator and the addition of the lead and 33241 covers the removal.
> 
> Cristine Ward, CPC



Yes, I agree with Casper204. The generator change codes are really only used when no lead placement is performed. As soon as you add a (right) lead it becomes a complete system. An exception would be if a generator was replaced and an LV lead was added then you would use the appropriate generator change code and 33225.


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## CodingKing (Jun 11, 2016)

I'd like to add a second, I concur with Casper204 and why

There is really a handy 3 column table in the CPT book. Once of the option is conversion from single chamber to dial chamber. The 2 columns describe the codes for a Pacemaker  or ICD. Under ICD column it says 33249 + 33241.

I really love the charts in the CPT book, It makes these types of situations so much easier.


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## Ajesh Kuriakose (Jun 13, 2016)

twizzle said:


> Yes, I agree with Casper204. The generator change codes are really only used when no lead placement is performed. As soon as you add a (right) lead it becomes a complete system. An exception would be if a generator was replaced and an LV lead was added then you would use the appropriate generator change code and 33225.



This is for a changing a system to biventricular system, not just for a normal upgrading of single chamber to dual chamber. For a normal upgrading use 33241+33249 - Upgrade single chamber system to dual chamber system


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