Ask Dr. Z

Patient has an existing resynchronization ICD, in need of LV lead replacement. Physician explored the CS and LV, but was unable to place a new lead in the CS or LV, so instead placed a new lead in the left bundle. The old LV lead was capped. Would you assign 33216 for the bundle of His lead or 33224 because the lead is being used for LV pacing?

"We accessed the CS. The chronic LV lead was noted to be in an apical posterolateral branch. The existing branch of the lead was the only amenable lead for LV lead placement. There were no other CS branches that were amenable for any lead positioning. At this point, I abandoned placement of the LV lead, and we placed a Medtronic 3830, 69 cm lead, serial number LFFF313853V, date of implant 01/21/2021 utilizing RAO and LAO fluoroscopic guidance into the region of the fluoroscopic left bundle. There was narrowing, but incomplete capture of the left bundle. This was felt to be a good lead position. The chronic RA and RV leads were connected to the pulse generator. The left bundle lead required an LV-1 adaptor"