Ask Dr. Z

We need some guidance, not sure if we should just report 33207 here? Or 33207/33225? Or unlisted? This was an initial implant with RA and RV ports plugged.

"The Seldinger technique was utilized to access the left axillary vein. A Wholey wire was positioned in the SVC. Due to recent tricuspid valve surgery for severe tricuspid regurgitation and concerns of recurrent tricuspid valve regurgitation if pacing lead is placed through the tricuspid valve, decision was made to place ventricular pacing lead in the coronary sinus. A 9 French peel-away sheath was advanced over the third guidewire. The CS was successfully cannulated using a Medtronic MB2 diagnostic catheter, deflectable QUAD catheter, and the Wholey wire. A venogram through the MB2 sheath showed a large size posterior lateral CS branch terminating at 3:30 o'clock on MA. A quadripolar, pace/sense lead was positioned in the lateral cardiac vein initially using a Choice PT wire. The RA and RV ports were plugged. Generator St Jude model PM3562 LV Lead St Jude 1458Q/86."