Ask Dr. Z

Your reference book defines “multi-lead device” for PPM/ICD implant/revisions as biventricular, and states a multi-lead device does not need an atrial lead (pg. 546/560). CPT clearly defines "multi-lead" as leads in three heart chambers. CPT Assistant, 12/2013, clarified: “When a LV lead is implanted, the system is referred to as a multiple lead system.” But CPT further clarified their guidelines in 2015 and continues to reiterate their definition of multi-lead for 33206-33249, 33264 as a device “with pacing/sensing function in 3 or more chambers of the heart”. Please clarify if/when it is appropriate to report multi-lead codes (33229, 33264, 33221, 33231, and 93281, 93284) for devices that only have RV/LV leads? Is it correct that we code dual chamber biventricular devices as “multi-lead” when it comes to device revision codes, but they are considered “dual chamber” for programming evaluation codes? So we could conceivably report 33229 for a multi-lead PPM generator change in a patient with LV/RV lead, but would subsequently report 99280 for dual chamber programming evaluation on the exact same system?