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LBBP Left Bundle Branch Pacing leads

Date: Feb 24, 2021

Question:

We were wondering from a coding aspect if you would treat LBB leads for left bundle branch pacing any differently than Bundle of His leads? Our facility is leaning towards following the AHA HCPCS guidance from 2019 and using the unlisted codes for the BOH, but since that guidance does not specifically address the LBB leads they are wanting to code them differently:

We have a patient who received a PM insertion with three leads: an RA, an RV, and a BOH lead. They are wanting us to utilize 33999 to encompass the entire procedure (both 33208 + 33225).

However if the same patient receives a PM insertion with three leads: an RA, an RV, and a LBB lead, they are wanting us to bill 33208 and 33999 and map the 33999 back to the 33225 code only.

On the professional side, we have concerns with coding them differently, as we are not seeing a difference in their purpose: both the BOH and LBB leads are replacing the use of the a traditional LV lead. We already have concerns with denials, as we know that MA Products are not going to pay for unlisted codes. What are your recommendations?

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