Wiki 33223 billed with 33264

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can you bill a pocket revision (33223) with a cardio defibrillator replacement 33264?

under what circumstances can you bill a pocket revision?
 
We were told that you can't bill separately for the pocket revision unless: You are changing from a PM generator to an ICD generator due to the increase in size, or unless you are actually creating a new pocket in a different location. Otherwise the pocket revision is now included in the generator implant.
 
I remember hearing it during a webinar that I can't put my hands on the print out right now. However, the 2013 Cardiac Rhythm Management Coder by Medlearn publishing gives several examples of ICD replacements on page 109 and the only one they code the 33233 with is "Existing PM is remvoed and the RA and RV leads are capped. New dual chamber ICD generator and leads are implanted ."

All other examples of ICD to ICD, the 33233 is not coded.

Hope this helps,
Tammy
 
This is from Dr. Z's Diagnostic & Interventional Cardiovascular Coding Reference 2013 (pg. 441):

Do Not code for pcoket revision during generator change to accomodate a different shaped or larger sized generator. This is considered part of the replacement, just like pocket creation is considered part of an initial insertion of a new device.

Do code 33223 for pocket revision for moving or relocating the pocket for infection, unplanned migration of generator, moving to a submuscular location for "twiddlers," and erosion or potential erosion of skin by the generator.

HTH
 
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