Ask Dr. Z

Patient had a single lead defibrillator with RV in place and plans to upgrade to biventricular with addition of RA and LV leads. Provider made three attempts to place an LV lead, then a Bundle of His lead, and finally a traditional RA lead. Due to a previously placed dialysis catheter that extended to the mid-lower position of the RA, access was difficult and all lead attempts failed. The LV lead was never placed in the body (only the catheters and guidewires), but both the BOH and the traditional RA were placed in the body before failure. At the end of the procedure, all we succeeded in doing was replacing the generator. Do I just stick to billing what we were able to complete and bill 33262 for the generator change and use modifier -22 for the additional work (time and difficulty in trying to place the other leads)? Or I know you have said in previous questions that if the lead itself is placed within the body we can bill for a discontinued procedure so bill 33262, 33216-53 x 1 (for the RA/BOH lead attempts since they were for the same purpose). Thoughts?