Ask Dr. Z

"Patient upgraded from dual ICD to biventricular ICD. Surgeon was unable to access the coronary sinus for the LV lead. The CS sheath was withdrawn to the right atrium, and wires were advanced to the heart. Over remaining wire the pacing sheet was advanced to the right atrium. Then, the wire and sheath were advanced to the right ventricle, and the sheath was positioned into the high basal RV septum approximately 2 cm distal to the aortic valve. Lead was tested, which demonstrated a septal paced morphology with a wide QRS. The lead was then screwed deep into the septum."

We have 33264 for the upgrade, but since the surgeon is attempting LV lead (and that is the intent) but has to come into the septum, would you report code 33225 or 33999?