# Replacement of generator and atrial lead



## Summer (Jul 26, 2012)

Question:  when a physician replaces a generator (from a dual chamber) and capped an existing atrial lead then inserted a new atrial lead which CPT codes should we be using?

Thank you in advance.


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## dpeoples (Jul 26, 2012)

Summer said:


> Question:  when a physician replaces a generator (from a dual chamber) and capped an existing atrial lead then inserted a new atrial lead which CPT codes should we be using?
> 
> Thank you in advance.



Pacemaker or ICD?


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## Summer (Jul 26, 2012)

Pacemaker.

Thanks Danny!


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## dpeoples (Jul 26, 2012)

Summer said:


> Question:  when a physician replaces a generator (from a dual chamber) and capped an existing atrial lead then inserted a new atrial lead which CPT codes should we be using?
> 
> Thank you in advance.



Based on your answer of pacemaker, I would code:

33233 for removal of old pacer pulse generator
33208 for placement of new pulse generator (dual lead/atrial and ventricular), this code inlcudes the new atrial electrode placement.

This is not my primary field, perhaps others will weigh in.

HTH


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## jsccollins (Aug 7, 2012)

*Generator Change and New RA Electrode*

The proper way to code the case you describe is as follows:

33233 - Removal of permanent pacemaker pulse generator only
33206 - Insertion of new or replacement of permanent pacemaker with transvenous electrode(s); atrial

It is a little goofy appearing at first because the patient is being sent home with a functioning dual chamber pacemaker system.  However, the AMA clarified a few years back that we are supposed to use the system implant code that accurately describes the hardware that the doctor personally implanted.  In your case, the doctor implanted a generator and a new atrial lead - this is the definition of code 33206.  We would not want report 33208 because it would compensate us for the implantation of a generator, a right atrial lead, and a right ventricular lead - auditors would pounce on this as over coding if the report was selected for audit.

Hope this helps; Jim Collins, CPC, CCC - President CardiologyCoder.Com


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## dpeoples (Aug 7, 2012)

jsccollins said:


> The proper way to code the case you describe is as follows:
> 
> 33233 - Removal of permanent pacemaker pulse generator only
> 33206 - Insertion of new or replacement of permanent pacemaker with transvenous electrode(s); atrial
> ...



That makes sense, thanks for the explanation. Practically speaking it does not matter how many chambers the replacement PG has, only now many leads are placed.


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