Ask Dr. Z

Our patient already had a biventricular ICD in place with LV lead failure. Physician is documenting that we changed out the generator, capped the LV lead, and placed a new HIS bundle pacing lead in what is documented as across the tricuspid valve and positioned in the lower right atrial septal wall. So I believe this means I now have one RV lead and two RA leads. Provider is requesting to bill codes 33264 and 33216. I know that typically when we replace the generator and add a lead at the same time we switch to the insertion codes. I am wondering if code 33206 is appropriate in this case or if we should be using unlisted code 33999. I know we capped the LV lead, but I do not feel that the new lead is trying to take the place of the LV function, but stimulating the atria.