Ask Dr. Z

Z-Health Diagnostic and Interventional Cardiovascular Coding Reference book, page 406 number 9, states "Do not code pocket revision during generator change to accommodate a different shaped or larger sized generator. This is considered part of the replacement, just like a pocket creation is considered part of an initial insertion of a new device". Per the above, codes 33262,33263 and 33264 should not be billed with 33223 if done only to change the size of the pocket. What if the physician had to remove scar tissue or debride the pocket at the time of ICD replacement, could we then bill for 33223? Per the CCI edits I can bill 33223 with the replacement codes and add a 59 modifier to 33223. Please help clarify this because the physicians want us to bill the 33223. Thank you