Cardiology Coding Alert

Question: Our cardiologist placed a left ventricular epicardial lead to re-establish biventricular pacing for a patient with severe congestive heart failure with marked left ventricle enlargement. The patient previously had transvenous biventricular pacing, but his coronary sinus lead became dislodged. The physician's attempts to re-insert it failed, and he decided instead to place an epicardial lead for biventricular pacing. How should I code this?

Wisconsin Subscriber  Answer: Pacemaker system placement includes the pulse generator electronics and battery and one or more electrodes or leads. CPT specifies that the physician may insert the electrodes through a vein (transvenous) or the physician may position them on the surface of the heart (epicardial). CPT also states that the epicardial location of electrodes requires a thoracotomy for the electrode insertion. You should review the operative note documentation for the method of electrode placement to select the appropriate code. 
 
In this instance, the physician placed an epicardial lead. You would choose a code from the 33200-33201 series, depending on the approach for the placement. These codes also include the pacemaker generator insertion, which, according to this scenario, did not occur. There is no specific code for epicardial lead placement for biventricular pacing, so you should append modifier -52 (Reduced services) to the appropriate epicardial lead placement code (33200-33201) for the reduced service.