Ask Dr. Z

We have a patient who had open heart surgery and also had a CRT device placed at the same time. An epicardial lead was placed on the right ventricle, left ventricle, and right atrium. So CPT code 33202 is being reported for the epicardial lead placement and also 33221 for insertion of pacemaker pulse generator with multiple leads. My question to you is would you also code for 33225 for the insertion of pacing electrode for left ventricular pacing at the time of insertion of the pulse generator? I am questioning code 33225 because all the guidance that is available on this code suggests that is transvenous only, and this was done epicardially during open heart surgery.