# Coding of permanent Medtronic 35cm bipolar epicardial left ventricular lead



## Carolyn.Stedman@nchmd.org (Feb 4, 2015)

Hoping someone maybe able to help me...

A physician performed a CABG x3 and then states placed a permanent left ventricular epicardial lead. Per DC summary, this was placed with anticipation of IV pacer in future.  Can this be coded, if so, what code and why?  In my research it looks as though it must be attached to a new pacer or an established pacer.  Any assistance is greatly appreciated.

Carolyn


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## Misty Dawn (Feb 4, 2015)

Carolyn.Stedman@nchmd.org said:


> Hoping someone maybe able to help me...
> 
> A physician performed a CABG x3 and then states placed a permanent left ventricular epicardial lead. Per DC summary, this was placed with anticipation of IV pacer in future.  Can this be coded, if so, what code and why?  In my research it looks as though it must be attached to a new pacer or an established pacer.  Any assistance is greatly appreciated.
> 
> Carolyn



For epicardial LV lead placement by the surgeon use: 
33202-thoracotomy, median sternotomy, subxiphoid approach
or 33203- thoracoscopy, pericardioscopy

CPT lists "When epicardial lead placement is performed with insertion of the generator, report 33202, 33203 in conjunction with 33212, 33213, 33221, 33230, 33231, 33240)"  
This is not saying that one of these codes needs to billed the same day. It is just noting the appropriate CPT code for the generator if an epicardial lead is placed.  Your example above the surg would bill for CPT 33202 or 33203 and at a later date or evening later that day the cardiologist would bill 33212, 33213, 33221, 33230, 33231, 33240. 
A good free reference I use is the AMA demo reference guide at http://www.cenveomobile.com/i/27249/59. The below is taken from there regarding epicardial LV lead placement. 

"The electrodes (leads) of a pacing cardiovert-defibrillator system are positioned in the 
heart via the venous system (transvenously) in most circumstances. In certain circumstances, an additional electrode may be required to achieve pacing of the left ventricle (bi-ventricular pacing). In this event, trans-venous (cardiac vein) placement of the electrode should be separately reported using code 33224 or code 33225. *Epicardial placement of the electrode should be reported using code 33202 or code 33203*."

HTH,  Misty Sebert CPC, CCC, CCVTC


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