Ask Dr. Z

I have a case where the cardiologist put in a dual chamber pacemaker (33208-KX). The following day the patient had chest pain and palpitations, so the note says the patient will have revision of pacemaker and leads. I am not sure how to code this revision. Here is the revision report: "An incision was made inferior to clavicle. Dissection was carried down to myofascial plane and then continued caudally to form a pocket for the generator. The atrial lead was placed in the atrial appendage. Ventricular lead was placed in right ventricular septum. Suture was used to secure the new leads. The leads were pushed in about another 2-3 cm to provide more slack. Thresholds and impedance were excellent. New generator was securely attached to the leads and placed in pocket." Would this be just a revision (33215), or would you code this as removal and replacement of the entire system?