Cardiology Coding Alert

Question: How should we code the following procedure? The cardiologist repositioned a dual-chamber pacemaker from the left side to the right side. She capped the electrodes on the left side. The doctor made the change because the patient was diagnosed with carcinoma of the breast on the left side and needed to have radiation therapy. She placed new leads on the right side. Louisiana Subscriber Answer: You should use 33217 (Insertion of a transvenous electrode; dual chamber [two electrodes] permanent pacemaker or dual chamber pacing cardioverter-defibrillator) for the lead inserts and 33222 (Revision or relocation of skin pocket for pacemaker) for the pocket relocation. If the cardiologist placed a new generator, use 33208 (Insertion or replacement of permanent pacemaker with transvenous electrode[s]; atrial and ventricular) and 33233 (Removal of permanent pacemaker pulse generator). You should also report 71090-26 (Insertion pacemaker, fluoroscopy and radiography, radiological supervision and interpretation; professional component) for the fluoroscopy service used to implant the two leads.