# Billing 33223 w/33262



## amym (Apr 26, 2013)

We have performed a Single Chamber ICD generator change and pocket revision.  The pocket revision was done to accomodate the size and shape of the new ICD.  Medicare bundled CPT 33262, the generator change, into 33223.  Is it ok to append a -59 modifier to CPT 33262 under this circumstance?  -Thanks


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## twizzle (Apr 26, 2013)

*Pocket revision*



amym said:


> We have performed a Single Chamber ICD generator change and pocket revision.  The pocket revision was done to accomodate the size and shape of the new ICD.  Medicare bundled CPT 33262, the generator change, into 33223.  Is it ok to append a -59 modifier to CPT 33262 under this circumstance?  -Thanks



You can append modifier 59 to 33223 but the pocket revision needs to be extensive, not just 'the pocket was revised to accommodate the new generator'. If they just did the minor revision, don't bill it. I only bill it if the revision is extensive or a completely new pocket is created due to migration of the device , or the device is very superficial and causing pain requiring  complete remodelling of the pocket. In these instances I use Dx code 996.72 and ,if applicable, a pain code per ICD-9 instructions.


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## amym (Apr 26, 2013)

"The pocket was made bigger to accomodate the bigger footprint of the defibrillator and irrigated with antibiotic solution."  Would this qualify as extensive?


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## twizzle (Apr 26, 2013)

amym said:


> "The pocket was made bigger to accomodate the bigger footprint of the defibrillator and irrigated with antibiotic solution."  Would this qualify as extensive?



No, definitely not. That scenario happens with most generator changes. "Extensive" and "revision" are really the keywords here. 
These are my opinions only but, from experience, they are appropriate.


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## bmasser (Sep 17, 2013)

Wouldn't the mod go on 33262 since medicare is bundling that code into 33223?


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## magmae (Sep 18, 2013)

check the ncci edits for both codes.  the 59 would go on the column 2 code


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