Q & A with Dr. David Zielske

Question    

Definition of ICD replacement codes 33262, 33263 and 33264

I think I have been misinterpreting the definition of ICD replacement codes 33262, 33263 and 33264. My understanding of these codes was that the number of chambers explanted had to match the number of chambers implanted. In the case of a dual chamber ICD generator only being explanted and a multi chamber ICD being implanted with the use of two existing leads and implantation of a LV lead, we are being instructed to use 33264. I thought it should be coded 33241, 33230, 33225.
 
However, I see that the CPT parenthetical notes under 33230 for implant generator only with existing dual leads instructs us to “NOT report 33230 with 33241 for removal and replacement of the ICD pulse generator. Use 33262-33264 when pulse generator replacement is indicated.” Code 33241 is for removal only not replacement; is this a misprint in the parenthetical notes? If we are to use 33262-33264 in this instance, do I understand that it doesn't matter what we are explanting, we only code by what we are implanting?

Answer
Code for replacement by what is put in at the end.  In your scenario, they removed an existing generator and put in a multi-lead generator and inserted an LV lead using the existing RV and RA leads.   Report codes 33264 and 33225 here.  Add code 93641 if DFT testing is performed.