Ask Dr. Z

Our patient had an existing biventricular defibrillator and was experiencing toning in her existing RV lead, which led the provider to believe it was fractured. My provider performed a revision of a CRT-D system by disconnecting and capping the existing RV pace/sense lead and connecting a capped RV ICD pacing lead to the active circuit (that had been placed previously).

The provider tried to bill it as a pocket relocation simply because he revised the pocket medially to eliminate encroachment across the left deltopectoral groove. I disagree with that strategy. The existing generator was placed back in the pocket, and we reused a lead that had already been placed and had been capped, so no new hardware was implanted. Would this be covered under a lead reposition 33215, or would there be something more appropriate, or should we use an unlisted code?