# Pocket revision w/removal + replace pacing cardio-defib pulse generator



## coders_rock! (Apr 10, 2013)

Good day,

Can you bill cpt code 33223 with 33263?

Thank you...


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## twins1195 (Apr 10, 2013)

No. Per Medicare CCI edits 33223 cannot be billed with 33263.


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## j.monday7814 (Apr 10, 2013)

actually the CCI edits show 33263 is a column 1 code and 33223 is a column 2 code which can be billed together with a modifier. I read an article from Z Health on this situation and it can be separately reportable under certain circumstances.

during a normal generator change, a certain amount or work to revise the pockets and free the leads and generator is required and built into the code. But if the new generator is significantly larger or the pocket needs to be moved slightly or made deeper to relieve patient pain then those situations are separately reportable.

What does your report state "coders_rock!"??


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## coders_rock! (Apr 10, 2013)

It states:

 "He is referred for ICD pocket revision and to replace the ICD with a device better suited to his shoulder.                       and 

The subcutaneous pocket was expanded medially to accommodate the shape of the new pulse generator. 

Does this qualify to report the revision code?


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## j.monday7814 (Apr 10, 2013)

I think that would qualify for 33223, that's a good statement to show medical necessity.


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## theresa.dix@tennova.com (Apr 11, 2013)

jeremym@pimaheart.com said:


> I think that would qualify for 33223, that's a good statement to show medical necessity.



I agree. Here is The information I refer to about pocket revisions.

Pocket revision  is generally only billable when a chronic generator is repositioned or when upgrading from a pacemaker to a defibrillator. It is necessary to attach the separate procedure modifier (59) to code 33223 when reporting pocket revision during a procedure involving upgrading from a pacemaker to a defibrillator. This modifier establishes that a true pocket revision was performed rather than simply opening the pocket to explant the chronic pacemaker generator


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