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April Posted Mon 24th of June, 2019 11:09:24 AM
My question is when a device generator is changed and the generator is for a multi lead system but they only hook up 2 of the leads. Would you code a multi generator or a dual generator placement?? Scenario: Existing Multi lead ICD system with LV/RA/RV. Device is at ERI, decision is made to Down grade to a PM multi lead system. During the gen change they decided to cap the RV lead. end result was Insertion of new PM generator, hook up of existing LV/RA leads, capping off of the RV lead and ICD generator removal. Would you code a multi generator 33221 or a dual generator 33213 placement??
SuperCoder Answered Tue 25th of June, 2019 03:55:14 AM

Hi April,


You should report CPT code 33228 for the performed procedure. CPT code 33228 includes removal of permanent pacemaker pulse generator with replacement of pacemaker pulse generator with insertion of dual lead system. Provided CPT codes do not include the removal of pacemaker.


Hope, provided information would be helpful.



April Posted Tue 25th of June, 2019 06:27:42 AM
33228 is removal of PM gen and replacement of a PM gen. They removed a ICD and replaced it with a PM. Would that still be the correct code?
SuperCoder Answered Wed 26th of June, 2019 08:15:45 AM

Hi April,


We agree with you. This is one of the tricky scenarios. There is no CPT single CPT code for replacement of ICD with pacemaker. In this case we will have to bill two codes, one for removal of ICD and other for insertion of pacemaker. Please use CPT code 33241 (Removal of implantable defibrillator pulse generator only) and 33213 (Insertion of pacemaker pulse generator only; with existing dual leads). There is no bundling issue between these two codes. Kindly bill both these codes for the performed procedures.



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