Ask Dr. Z

I think I have been misinterpreting the definition of ICD replacement codes 33262, 33263, and 33264. My understanding of these codes was that the number of chambers explanted had to match the number of chambers implanted. In the case of a dual chamber ICD generator only being explanted and a multi-chamber ICD being implanted with use of two existing leads and implantation of a left ventricular lead, we are being instructed to use code 33264. I thought it should be reported with codes 33241, 33230, and 33225. However, I see that the CPT parenthetical notes under code 33230 for implant generator only with existing dual leads instructs us to NOT report code 33230 with 33241 for removal and replacement of the ICD pulse generator and to use codes 33262-33264 when pulse generator replacement is indicated. Code 33241 is for removal only not replacement.  Is this a misprint in the parenthetical notes?  If we are to use codes 33262-33264 in this instance, am I understanding that it doesn't matter what we are explanting, we only code by what we are implanting?