Ask Dr. Z

Per Ask Dr. Z question ID #6250, Dr. Dunn advised coding based on the type of generator replaced. For the case below, will we use code 33228 (dual chamber pacemaker generator) for what was placed, or should we use code 33227 (single chamber) for what it is pacing?

"Patient came in for replacement of dual chamber pacemaker battery, which was carried out. Right ventricular lead was left in place and capped. Right atrial lead was left in the right atrial appendage. Guidant Model 1298 generator was removed from the chronic leads. Leads were inserted into the header of the new generator, Boston Scientific Ingenio Mode 390813 (C1785), tightened in place with immediate pacing,  sensing noted, and pocket closed." Later the same day, an addendum was added to supplement the operative note: "Severe scar tissue over leads and generator. When checked, ventricular lead was not capturing, but atrial was working. We were unable to advance wire into proximal subclavian. When given contrast, vein appeared occluded. Instead of going to right side, we assessed the AV, and it was conducting 1:1 even at rate of 140. We implanted generator on this side and put patient on AAI mode."