# Help...are my codes correct



## perkins05 (Sep 18, 2012)

PREOPERATIVE DIAGNOSIS:
Malfunctioning automatic implantable cardiac defibrillator system,
end-of-life indicators and generator.

POSTOPERATIVE DIAGNOSIS:
Malfunctioning automatic implantable cardiac defibrillator system,
end-of-life indicators and generator.

OPERATIVE PROCEDURE:
Replacement of automatic implantable cardiac defibrillator
generator, replacement of right ventricular sensing lead.

DESCRIPTION OF PROCEDURE:
After the placement of adequate intravenous access and arterial
line, general anesthesia was induced.  Routine sterile prep and
drape was conducted over the left chest.  The skin incision over the
old AICD generator was sharply incised.  Soft tissue was dissected
with the use of the electrocautery.  There was an abundant amount of
subcutaneous tissue.  The device was then a submuscular pocket.  It
was dissected from surrounding tissue with care taken to avoid any
damage to the leads.  The device was delivered and detached from the
leads.  The problem with the system was artifactual sensing in the
RV lead.  The patient was being shocked through 2 epicardial patches
which had been placed via a subxiphoid approach several years ago.
Subclavian venous puncture was performed via a separate stab wound.
Under fluoroscopic control a guidewire was passed and then an
appropriately sized tearaway sheath.  It was necessary to dilate the
subcutaneous tissue progressively under fluoroscopic control to
allow passage of the sheath.  Through the sheath was now advanced a
new right ventricular lead.  This was a Biotronik lead.  It was
manipulated under fluoroscopic position to an appropriate site in
the right ventricle and electrical parameters were tested.  The lead
was secured at the level of the subclavicular incision and tunneled
to the previously created pocket.  A new generator which was a
Biotronik Lumax 450 VR-T was brought to the field.  Appropriate
electrical connections were made.  The device was placed in the
previously created pocket, activated and programmed.  Defibrillation
threshold testing was performed.  Initially the device failed to
rescue with shock up to 40 watt seconds.  The shocking configuration
was reprogrammed with a biphasic shock given in a reversed manner
from previous attempts and this time the device appropriately
identified and terminated induced ventricular fibrillation with a
single shock of 30 watts seconds.  The device was now temporarily
deactivated as the wound was closed in layers using absorbable
sutures and skin staples.  At the end of the procedure, the device
was activated and programmed.  The patient awakened, extubated and
transported to recovery room in stable condition.


codes 
33249
33241
33244


----------



## AB87 (Sep 18, 2012)

I say 33249 ... with Dx Code 996.04


Insertion or *replacement of permanent pacing cardioverter-defibrillator system with transvenous lead(s), single or dual chamber* 






Lay Description      

---- 
 The physician inserts or replaces a permanent pacing cardioverter-defibrillator system, including the pulse generator with transvenous electrode placement. Transvenous placement is currently the most common technique for placing implantable cardioverter-defibrillator (ICD) electrodes. An ICD is a device designed to administer an electric shock to control cardiac arrhythmias and restore a normal heartbeat. Local anesthesia is administered. An incision is made in the infraclavicular area. The subcutaneous tissue is opened and a pocket is created for the pulse generator. Transvenous electrode placement is performed under separately reportable fluoroscopic guidance. The electrode catheter is advanced through the superior vena cava into the heart and placed in the appropriate site in the right ventricle (single chamber system) or in the right ventricle and atrium (dual chamber system). Multiple leads may be required for both single and dual chamber systems. Once all leads are placed, they are tested and connected to the pulse generator that is placed in the previously prepared pocket. All incisions are closed.


----------



## em2177 (Sep 18, 2012)

Pacemaker (end of life) cpt codes:

33227 - removal of PM generator with replacement of PM generator; single lead system
33228 - dual lead system
33229 - multiple lead system

ICD 9 code: V53.31

AICD (end of life) cpt codes:

33262 - removal of ICD generator with replacement of ICD generator; single lead system
33263 - dual lead system
33264 - multiple lead system

ICD 9 code: V53.32


----------



## Misty Dawn (Oct 22, 2012)

crump05 said:


> PREOPERATIVE DIAGNOSIS:
> Malfunctioning automatic implantable cardiac defibrillator system,
> end-of-life indicators and generator.
> 
> ...



Yes to 33249 it includes the removal and replacement of the ICD and the addition of a single or dual electrode.  *Don't forget to code 93641 for induced arrythmia (vfib)!!*
No to 33241 is for removal only. (This is usually performed when a pt has infection so they take the ICD out only without replacement that same day).
No to 33244 is for the removal of a transvenous lead.  The pt existing leads are epicardial leads and the dictation sounds like he left the epicardal lead in but did not attach it.  Can not bill anything for disconnecting a lead and leaving it in. (*there are specific epicardial lead codes 33202-33203 & 33236-33237). The new lead he inserted is a transvenous lead included in the 33249.


----------

