Ask Dr. Z

A patient presents with biventricular ICD pulse generator change due to ERI along with LV malfunction. The provider removes and replaces the generator and decides to cap the malfunctioning LV lead and then inserts a new LV lead, all at the same session. Would it be more appropriate to report codes 33249 and 33241, as CPT only indicates lead (table on pg. 177) without clarifying which one(s)? Or would it be appropriate to bill as you would for an upgrade with codes 33225 and 33264? Also, per CPT Assistant June 2012, Vol. 22, Issue 6, there is a tip indicating that code 33225 can be used with 33264, yet indicates this is for generator upgrade... and goes on to say for code 33264: "Codes 33262-33264 should be reported when the sole procedure is the replacement of a pacing cardioverter-defibrillator pulse generator and the procedure does not include the insertion or replacement of a right atrial and/ or ventricular electrode(s)." It does not clearly indicate if the ventricular electrode(s) are right or left. How would you recommend coding the above scenario?