# 33223 revision of pocket



## Coder708 (Dec 3, 2009)

Hello All looking for some help with this code 33223.

Doctor performed BIV ICD upgrade so I used 33240 &33241.  Now he also did pocket revision which I want to use 33223 but all the CCI edits say it is included.  The old pocket was in left pectoral and note states that patient was so thin that the new pocket had to be relocated to submuscular pocket.  Do you think it is appropriate to use the 33223??  

Any advice would be appreciated .
Thanks


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## cweavercpc (Dec 4, 2009)

*BiV Upgrade*

Can you clarify for me what was upgraded? Was this and ICD upgraded to a BiV- ICD ? or a PPM upgrade to a BiV-ICD?

Did you bill the appropriate 33224 or 33225 for the BiV lead? Both of these codes include revision of pocket, removal, insertion, and/or replacement of the generator.

If this was a PPM upgrade to a BiV-ICD - 33233, 33225, 33240

If this was an BiV-ICD upgrade to a previously placed ICD and generator- 33224

Hope this helps!


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## Coder708 (Dec 4, 2009)

Yes it BIV-ICD upgrade to previous placed ICD w epicardial electrode

So I should use 33224- 33202? & 33240 33241


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## cweavercpc (Dec 4, 2009)

Ok I think I got. Sorry for the confusion. I would bill. 

33225- for the BiV upgrade
33240- for the insertion of new generator
33241- for the generator removal

As for the 33223 , that is a tricky one.  I see the 33222 specifically states relocation but only for the PPM and the 33223 only states revision.  

Also the edits do show 33241 and 33223 to be mutually exclusive, and the 33240 and 33223 to be bundled. It does state that unbundling is allowed with the appropriate modifier.  You could try to bill the 33223 with a -59 modifier.  I do not know for certain it will pay.  I have never billed this code combination. 

If you did an epicardial electode I am honestly unsure what to bill... I just caught that you stated epicardial, we have never placed those... attempting it I would try 33224,33202 ( the 33240, and 33241 are included in the 33224 description)


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## jewlz0879 (Mar 25, 2011)

C. Weaver

Can I find what you said, "If this was an BiV-ICD upgrade to a previously placed ICD and generator- 33224" in writing by chance? I have a coder continually arguing with me because they they it should be 33240, 33241 and 33225. I thought you were to only use 33225 if the patient has NO PREVIOUS ICD - which is not our case. We are upgrading and 33224 includes revision, insertion and removal of generator. 

Not sure you'll see this. I realize its an 'old' post. I pray you do! 

Thanks in advance!


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