Ask Dr. Z

No idea how to code this. Patient with NICM stage C and moderate LV dysfunction presents for ICD generator exchange due to single chamber device at ERI. Physician removes old generator and tests the single existing lead. But, instead of installing a single chamber ICD, physician places a dual chamber ICD and wraps the extra lead around the generator before placing it in the pocket. The dual code 33263 does not seem right because there is only medical necessity for a single chamber device. The single chamber code 33262 has lower reimbursement than the device that was actually placed. Code 33249 does not seem right because the new lead is just left in the pocket. If the physician later decides to unwind and utilize that extra lead, how would that be coded? Finally, do you know why the device may have been installed this way?