Ask Dr. Z

Could you please help with coding for the following OP note? Patient has an ICD implant. "Patient came in with RV lead fracture. I opened up his pocket and removed his existing pulse generator and disconnected it from the leads. I then took vascular access and implanted a new RV ICD lead. I then relocated the skin pocket superiorly since the lead implant was in a different location than the existing leads. I then capped the existing fractured RV lead. This is a single lead; however, it is a DF-1, which means that it has three electrodes and not just one. I capped all three electrodes. I then took the existing pulse generator and reconnected it to the existing RA and LV leads and also connected it to the new RV lead." When they remove and replace the same generator, I'm not sure if it would still be considered a "replacement" according to CPT language. Not sure if this should be coded as 33223 and 33216, or as 33241 and 33249?