# Upgrade of ICD to CRT-D with LV lead -



## MELJNBBRB (May 29, 2012)

Example the patient's dual ICD is upgraded to a BI-V CRT with LV lead placement and DFT.   So Cardiology coder suggest 33263,33225 and 93641. But that does not work with the C code that I have for the Device because its a BIV ICD. Help are you having issues with this also , and how are you coding these\

Any info is greatly appreciated! TIA


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## cargo (Jun 1, 2012)

According to the Heart Rhythm Society, you should use the code for the device being inserted, not the device being removed, so you would code 33264, 33225 etc.


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## jewlz0879 (Jun 1, 2012)

33263 is for removal and replace generator only (no lead removal or placement). That might be why you're encountering problems. 

If your physician putting in a whole new system and at least one lead? If so, I would bill for the ICD generator removal 33241. If he removed a lead(s), either 33243 or 33244. Then I would bill for the new system (including at least one lead) 33249, 33225 and 93641. 

If old generator and one lead are removed of a dual chamber ICD and a new single chamber generator is placed (no new lead) use code for single chamber generator exchange (33262) and lead removal (33244). (Just as an example).


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