# ICD Lead Revision/Reposition??



## CardioCoder79 (Jul 9, 2014)

Any opinions will be greatly appreciated. Should I bill 33241, 33244, 33215-59, and 33249? Or....should it just be 33215? I am not sure if code 33215 includes the removal and reinsertion of the generator. 

Thanks so much! 



PROCEDURE IN DETAIL:  After informed consent, the patient was brought into
the electrophysiology laboratory and prepped and draped in a sterile fashion.
Fluoroscopy over the ICD generator demonstrated what appeared to be a pin on
the right ventricular lead that was pulled back.  The patient received 2
grams of IV Ancef and was prepped and draped in a sterile fashion.  One
percent lidocaine was used for local anesthetic over the left chest wall over
the previous incision.  Utilizing a 10 blade, incision was made over the
previous incision, and utilizing a plasma blade, dissection was carried down
to the ICD pocket.  The pocket was opened, a small hematoma was evacuated.
There were no signs of infection.  The ICD generator was explanted.  The
pocket was flushed copiously with triple antibiotic solution.  Gentle
withdrawing pressure on the right ventricular defibrillation coil, the lead
pulled out of the generator.  It was re-implanted and secured in position and
tugged on with stability.  The SVC coil was withdrawn and re-plugged into the
can as well and secured for stability.  All leads were then checked for
stable connections.  The generator was placed back inside the pocket with
stable sensing and high-voltage thresholds.  Then, 500 mg of vancomycin was
placed inside the pocket.  The pocket was flushed in 3 layers with 3-0
Vicryl, 2-0 Vicryl, and 4-0 Vicryl.  The skin was cleaned with Chloraprep.
Staples were used over the skin.  A sterile dressing was applied, and all
counts were correct at conclusion of the case.


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## Misty Dawn (Jul 9, 2014)

Just 33215.  If within the global of the implant add modifier 78.


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