Cardiology Coding Alert

Question: My cardiologist removed an ICD lead, replaced it with a new one, and then tested it after he hooked the lead up to the generator. Which codes should I be using for this?

New Mexico Subscriber Answer: Although you need to provide more information to receive the accurate codes, generally you would report:
  the removal of the old lead with code 33244 (Removal of single or dual chamber pacing cardioverter-defibrillator electrode[s]; by transvenous extraction)
  the implantation of the new lead with code 33217 (Insertion of a transvenous electrode; dual chamber [two electrodes] permanent pacemaker or dual chamber pacing cardioverter-defibrillator)
  the necessary fluoroscopy with code 71090 (Insertion pacemaker, fluoroscopy and radiography, radiological supervision and interpretation).  Your cardiologist most likely performed an EP study to test the defibrillation threshold of the device and to confirm it was implanted and programmed appropriately.
 
For this service, you should report 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).  - You Be the Coder and Reader Questions were prepared with the assistance of Jim Collins, ACS-CA, CHCC, CPC, president of Compliant MD Inc. and compliance manager for several cardiology groups around the country; and reviewed by Jerome Williams Jr., MD, FACC, a cardiologist with Mid Carolina Cardiology in Charlotte, N.C.