Cardiology Coding Alert

Question: If an ICD lead dislodges during the global period of the insertion, can I report the repositioning?

Texas Subscriber

Answer: Yes, you may report repositioning a lead during the global of the implantable cardioverter-defibrillator (ICD) insertion. Be sure to append modifier 78 (Unplanned return to the operating/procedure room by the same physician or other qualified health care professional following initial procedure for a related procedure during the postoperative period) to explain why you’re reporting the code during the global of the ICD insertion.

Example: Suppose the cardiologist determines the right ventricular lead of a dual chamber ICD became dislodged during the global. He takes the patient back to the OR to disconnect the lead from the generator, reposition the lead, and reconnect it. He restores pacing. For this service, you should report 33215-78 (Repositioning of previously implanted transvenous pacemaker or implantable defibrillator [right atrial or right ventricular] electrode).