Ask Dr. Z

CRT-D generator replaced only and existing RV and LV leads reconnected. (No RA lead existing or implanted) –Would we code this as a dual lead or multiple lead replacement? We are finding conflicting advice--CPT Assistant, December 2013 states whenever a LV lead is implanted, it is a multiple lead system. A dual lead system refers to Right sided only pacing system (RA and RV). A 2017 webinar from another coding resource states BiV device does not always mean a “multiple” device is implanted. The example given: “A patient with chronic A Fib may not have a lead in the RA, but leads in the RV and LV. This case would qualify as a BiV device, but coded as a dual and not multi since only 2 chabers are paced, not 3” --- 2020 CPT guidelines state, “If only a pulse generator is inserted or replaced without any RA and/or RV lead(s) inserted or replaced, report the appropriate code for only pulse generator insertion or replacement based on the number of final existing lead(s) (33262, 33263, 33264).”