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PM Lead Removal with PVI RFA & LAA Exclusion

Date: Dec 16, 2020

Question:

"PROCEDURE: Infected cardiac pacemaker lead removal, pulmonary vein isolation, left atrial appendage exclusion. FINDINGS: Two leads fully removed via right atriotomy and opening of the innominate vein + SVC junction. Dr. T of Electrophysiology inspected all parts of the extracted leads. The innominate/SVC was then repaired, and right atrium was closed with suture. (CPT 33243???) // Bilateral pulmonary vein isolation with RFA AtriCure. Left atrial appendage excised and closed. Next, bilateral pulmonary vein isolation with RFA AtriCure was performed with three burns on each side until evidence of transmural lesions. The left atrial appendage was then clamped, resected, and oversewn with 4-0 prolene suture. A small residual appendage remained, however, was felt to be too close to the circumflex artery for further resection." Can PVI RFA and LAA reconstruction can be coded separately? Because EP was there, would this be 93656, or would 33256 be appropriate due to sternotomy? (The add-on codes are not applicable to 33243.) Or, is this bundled into 33243?

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