Ask Dr. Z

"Patient came in for elective subcutaneous pacemaker generator change. This was performed and seemed successful. But, prior to extubation, pacemaker lost capture. It was decided to replace the whole system. Patient was re-prepped and draped. A sternotomy was performed. Bipolar epicardial lead placement, with suboptimal parameters; a unipolar screw-in lead was then placed in the right ventricle at base of heart. Process was repeated, with same leads then placed in the right atrium free wall. Unipolar leads showed good threshold. The pacemaker pocket had been opened and subcutaneous pacemaker removed. All four new leads were tunneled to the pocket. Pocket was revised to hold new hardware. Bipolar leads were capped; original V-lead was also capped. New unipolar leads were connected to new dual chamber pacemaker." I know I need to report code 33202 for the epicardial lead placement. My dilemma is that the CPT Codebook says to use code 33202 with 33213 for pacemaker insertion with existing dual leads, but isn't code 33213 for when a previous generator is not being removed during same session? Would it be appropriate to bill either codes 33202/33228 or 33202/33214 for this scenario?