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Please do NOT include any actual patient medical records with your question. Dr. Z, I'm confused about your response to Q&A 3531, pasted below. From my understanding, I thought the 33262-33264 code set was only used when no lead changes were made. Please explain. Thank you in advance!! ZHealth Online Q&A 3531 Date: Monday, March 05, 2012 Question: Please do NOT include any actual patient medical records with your question. Dr. Z, I have a question about the new ICD coding. If a patient is having an upgrade from a dual chamber ICD to A Biv ICD with removal of old gererator and insertion of new geenerator,and LV lead insertion only, do I use 33263 and 33225, or 33264 and 33225, or other? Thanks. D Answer: I would recommend using the generator that was placed (not removed), which in this case would be 33264 along with 33225. This also applies to patients where you start with a dual lead system and end with a single lead generator......code for the single lead generator. Dr.z