# lead revision and dual gen change out



## lcouto (Aug 2, 2013)

Hi... I am not sure how to bill this.. I am thinking 33215 for lead revision and 33228 for generator change out. I have attached the report. Can someone advise if this is correct? Thanks

Pre-procedure Diagnoses 
  1. Pacemaker lead failure 
  2. Pacemaker generator end of life

  Post-procedure Diagnoses 
  1. Pacemaker lead failure  
  2. Pacemaker generator end of life 

  Procedures 
  1. LEAD REVISION 
  2. PPM GENERATOR CHANGE - DUAL

  BRIEF OPERATIVE NOTE


Pre-operative Diagnosis:  
Pacemaker lead failure
Pacemaker generator end of life


Procedure Performed :
Atrial Lead Revision
Dual Chamber Pacemaker Generator Change


Implants and Procedure Description:  
After informed consent was obtained, the patient was transported in a nonsedated condition to the cardiac catheterization suite. The patient was given moderate conscious sedation. The patient was prepped and draped in a sterile fashion and a "timeout" was taken.  


ACCESS and POCKET FORMATION:          
Lidocaine was used to infiltrate the skin and subcutaneous tissue overlying the left pectoralis muscle.  Utilizing a combination of sharp and blunt dissection, the pacemaker was dissected from the pocket in the prepectoral fascia.  The old pulse generator was removed. The atrial lead was disconnected,  Capped, and secured to the pectoralis muscle with 0 silk.  


The patient was placed in Trendelenburg position. Percutaneous access was obtained in the subclavian vein utilizing the modified Seldinger technique. An .035 wire was advanced into the right atrium under fluoroscopic guidance. Over the .035 wire a dilator and sheath were placed. The wire and dilator were exchanged then for the atrial pacing lead. The lead was an active fixation lead . Utilizing curved and straight stylettes, the lead was positioned and secured in the right atrial appendage. It was tested and found to have P waves of 3.0 mV, impedance 437 ohms, threshold was 1.2 volts, current 0.4 milliamps. Adequate slack was placed in the lead under fluoroscopic guidance. The lead was tested with an output of 10 V and did not stimulate the diaphragm. 


The in situ ventricular lead was tested and found to have R waves of 2.3 mV, impedance 409 ohms, threshold was 1.3 volts, current 0.4 milliamps. Adequate slack was placed in the lead under fluoroscopic guidance. 


CLOSURE:
The leads were then secured to the pectoralis muscle with non-resorbable suture. I then attached the pulse generator  The leads and pulse generator were incorporated in the pocket. The pocket was copiously irrigated. The subcutaneous fascia was closed with interrupted Vicryl suture. The skin layer was closed with a subcuticular Vicryl stitch. Final fluoroscopy demonstrated adequate slack in the leads. The wound was dressed in a sterile fashion.


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## Misty Dawn (Aug 2, 2013)

lcouto said:


> Hi... I am not sure how to bill this.. I am thinking 33215 for lead revision and 33228 for generator change out. I have attached the report. Can someone advise if this is correct? Thanks
> 
> Pre-procedure Diagnoses
> 1. Pacemaker lead failure
> ...




33215 is for repositioning of an existing lead.  In report Dr capped the atrial lead a placed a new atrial lead and replaced pm gen.  This is CPT 33206 and 33233.  

33206 includes the new gen and new RA lead 
33233 is removal of the old RA lead
Nothing was done with the RV lead

HTH,  Misty Sebert CPC, CCC


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## TWinsor (Aug 4, 2013)

I would code 33206 and 33233.  The capping of the lead is not the same as removal and cannot be billed separately. 

According to Dr. Z, if during a pacemaker generator replacement one or more leads are inserted or replaced utilize code 33206, 33207, 33208.  Choose code bassed on lead placed not generator type. You can bill for removal of generator and insertion of new with lead(s).

HTH!


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## lcouto (Aug 5, 2013)

Thank you very much for your help... Much appreciated


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