Ask Dr. Z

We are seeking clarification on the correct coding of two scenarios: LV lead removal and multiple lead removal. After extensive research, we are finding conflicting guidelines from multiple reputable coding resources. For LV lead removal, some say the LV lead removal is included in the appropriate removal code, whereas others say report unlisted for LV lead removal. For multiple lead removal (more than two leads), we found three different coding suggestions: 1) append modifier -22 when more than two leads are removed to capture the additional work; 2) report unlisted for multiple lead removal, as the current CPT codes do not capture multiple lead removal; and 3) report the appropriate removal code even if more than two leads are removed, as these codes cover all leads. These two scenarios overlap in some cases, which adds an extra layer of confusion (e.g. RA, RV, and LV lead removal). Please provide your expert opinion and rationale.