Wiki Ex says "leads" NOT "electrodes" So why is answer CPT 33202 Not 33208????

[Mrsrpc]

A patient presents for epicardial lead placement via median sternotomy to the right atrium and right ventricle. A dual pacemaker generator is then inserted subcutaneously. The patient has bundle branch block and sinoatrial node dysfunction. What CPT® code(s) are reported?

Selected Answer: d. 33208, 33213-51 Answers: a. 33214 b. 33203, 33213-51 c. 33202, 33213-51 d. 33208, 33213-51 Response Feedback: Rationale: Because leads were placed on the right atrium and right ventricle, it is a dual chamber system. Two codes are necessary to report placement of an epicardial system. The parenthetical note under 33203 directs the coder to report codes 33202 and 33203 with 33212, 33213, 33221, 33230, 33231, and 33240. Look in the CPT® Index for Pacemaker, Heart/Insertion/Pulse Generator Only. You are referred to 33212, 33213, and 33221. For the placement of the epicardial electrodes look in the CPT® Index for Pacemaker, Heart/Insertion/Electrode, and you are referred to 33202-33203.

 

[sls314]

I'm not a cardiology coder, but I'm going to take a stab at this anyhow...

In reading page 251 of the 2022 CPT book:

CPT 33202 description is "Insertion of epicardial electrode(s); open incision (eg thoracotomy, median sternotomy, subxiphoid approach)"

CPT 33208 description is "Insertion of new or replacement of permanent pacemaker with transvenous electrode(s) atrial and ventricular"

The question states that the patient presented for epicardial lead placement, so 33202 seems correct to me.

Transvenous is a different type of pacing than epicardial, which would rule out 33208 as a possible correct answer.

 

[Mrsrpc]

I'm not a cardiology coder, but I'm going to take a stab at this anyhow...

In reading page 251 of the 2022 CPT book:

CPT 33202 description is "Insertion of epicardial electrode(s); open incision (eg thoracotomy, median sternotomy, subxiphoid approach)"

CPT 33208 description is "Insertion of new or replacement of permanent pacemaker with transvenous electrode(s) atrial and ventricular"

The question states that the patient presented for epicardial lead placement, so 33202 seems correct to me.

Transvenous is a different type of pacing than epicardial, which would rule out 33208 as a possible correct answer.

Thanks. It does seem to use leads and electrodes interchangeably, which was why I was leaning towrds 33208 (I thought there was some nuance that differentiated them that I was unaware of and didnt' question the verbiage.)