November 2015 Q & A

Question: Upgrade from Dual Pacemaker to BiV AICD

The upgrade to a biV AICD from a dual pacer leads me to CPT codes 33230, 33233, and 33225. But this scenario is very confusing because the descriptor for 33230 says "with existing dual leads", so should I use 33231 because now with the addition of the LV lead that was implanted along with the BiV generator,  I have 3 total leads?
For  upgrade of a dual pacemaker to a biV AICD it involves removal of existing pacer (33233), presumably capping of the pacing RV lead (no charge to cap and not mentioned as removed), insertion of an LVL (33225) and for an AICD they will have to implant a defibrillating lead as well as a new defib generator (33249). Do not use the 33240-33231 range here as they are for someone who already has all the leads in place and only inserting a generator (not the case here). IF they also did defibrillation threshold testing at the conclusion, that would be 93641.