Ask Dr. Z

We have a patient who presented with a fractured RV defibrillator lead. The physician ended up changing out the generator and lead (the lead she needed was not available so changed generator and leads). HP - original device placed for ischemic cardiomyopathy with EF of 35% and EF has now recovered to near normal 50-55% with optimal medical management. We have to bill the original insertion codes, so it doesn't look like this patient will meet medical necessity for the device based on the documentation. Are you in agreement? Is it appropriate to code a history of chronic CHF now controlled with improved EF due to device as a secondary diagnosis if documented by the physician (if this is even a thing)?