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This question is similar to question 10455. Patient had an existing defibrillator with atrial, RV, and LV leads to start and presented for a multi-lead defibrillator generator exchange. Generator was exchanged and upon interrogation, RV lead showed significant electrical chatter, and was no longer functional. At this point the old RV lead was capped, and a new transvenous RV defibrillator lead was placed. How would this coding change since the device placed was a biventricular defibrillator? I don't believe that 33264 for multi-lead defib gen change can be coded with 33216 for transvenous lead placement. My guess is that we would code for 33241 for device removal, and also for 33249 for defibrillator insertion with placement of a new RV lead, but I am uncertain because the patient had a biventricular device. Please advise.