Cardiology Coding Alert

Question: A patient came in with an existing ICD. The cardiologist removed the ICD generator, added a coronary sinus lead, and inserted an upgraded ICD generator. The cardiologist did this under fluoro and left the existing atrial and ventricular leads in place. I need help with the codes.


California Subscriber

Answer: You should report code 33241 (Subcutaneous removal of single- or dual-chamber pacing cardioverter-defibrillator pulse generator) for the removal of the old generator. You should report the implantation of the new left ventricular lead with +33225 (Insertion of pacing electrode, cardiac venous system, for left ventricular pacing, at time of insertion of pacing cardioverter-defibrillator or pacemaker pulse generator [list separately in addition to code for primary procedure]) because the cardiologist is attaching the new ventricular lead to a new generator as apposed to an already implanted generator.

You'd also report the implantation of the new generator with 33240 (Insertion of single- or dual-chamber pacing cardioverter-defibrillator pulse generator). Don't forget 93641 (Electrophysiologic evaluation of single- or dual-chamber pacing cardioverter-defibrillator leads including defibrillation threshold evaluation [induction of arrhythmia, evaluation of sensing and pacing for arrhythmia termination] at time of initial implantation or replacement; with testing of single- or dual-chamber pacing cardioverter-defibrillator pulse generator) for testing of the defibrillator system (generator and leads) and 71090-26 (Insertion pacemaker, fluoroscopy and radiography, radiological supervision and interpretation; professional component), assuming your cardiologist documented each of these commonly performed services in the report

Note: Code 33225 is an add-on code, not a stand-alone code. That means you should use 33225 when the cardiologist places a new generator at the time of implanting the new left ventricular lead.