# HIS BUNDLE LEAD W/PPM



## aussome1 (Apr 16, 2020)

I have a physician that has started to put HIS Bundle Leads in when he does a pacemaker.  When we looked in our cardiac rhythms book it directed us to bill an unlisted code for the HIS Bundle. It doesn't give any information as to whether we should bill this as a 33207 (single lead) or 33208 (dual lead) PPM.  Typically he only does this as a HIS bundle and LV Coronary Sinus (33225).  We have been billing this as a 33207 - KX with a 33225.  We are wondering if we are billing it correctly this way?




We did a left arm venogram.  Following this, we cannulated the left axillary  vein.  Under fluoroscopy, *we inserted a Medtronic 3830 lead at the His bundle areas and nice His potential was recorded*.  The QRS was narrow with the pacing threshold 2.2 volts at 1 millisecond.  Impedance of 586 ohms.  R waves 1.8 millivolts.  Then, we cannulated the coronary sinus and positioned LV lead into the anterolateral branch of LV lead.  It is a Medtronic 4298 lead.  Impedance of 1483 ohms, R wave was 6.6 millivolts.  The pacing threshold was 1 volt at 0.5 milliseconds.  After the lead was secured pocket was irrigated with bacitracin.  The lead was connected to Medtronic Percepta biventricular pacemaker pulse generator.  Serial # was RNP211730 H.  Pocket was closed up with 2-0 Vicryl continuous suture layer from a deeper layer to superficial layer.  Sterile strips applied.  Patient tolerated the procedures well.


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## twizzle (Apr 16, 2020)

It is some time since I did any EP coding but I believe that putting a lead in the His Bundle is effectively the same as right ventricular pacing. The fact the provider is also using a biventricular pacemaker pulse generator seems to confirm this. From the little bit of research I did it seems as if direct His bundle pacing is more effective in producing synchronized ventricular contraction—and therefore in improving cardiac function—than apical pacing.

I think you are correct with 33207, 33225 but don't quote me on that. Just my interpretation.


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