Ask Dr. Z

"Patient underwent implantable defibrillator generator change with the addition of a new atrial lead. New lead needed due to fracture in existing chronic lead. Generator was at elective replacement. Chronic right atrial lead was detached from the chronic generator and capped. Chronic right ventricle lead was detached, examined, and then attached to the new generator along with the new right atrial lead." Since code 33249 includes the replacement of an existing generator along with the insertion of a single or dual set of leads, and the original lead was not removed (only capped), would we need to code 33241 for the removal of the original generator as we would if we had removed a lead (along with 33244)? Or would 33249 suffice for the entire procedure?