The doctor changed out / downgraded a biventricular (BiV) implantable cardio-defibrillator (ICD) to a BiV pacemaker (PPM) and also replaced a broken lead. Since charge codes 33229 and code 33216 will not allow a modifier, what codes do you recommend?
According to CPT directives, and the American Medical Association, when the battery (pulse generator) and a lead are both inserted or replaced, you need to use “system codes” (33206–33208 for the pacemaker) plus bill for the removal of the ICD (33241) separately. If the broken ICD lead was removed, you would report that removal separately as well with 33244.
So, that being said, the following would be the appropriate code to assign:
33241 Removal of implantable defibrillator pulse generator only
Depending on the procedure performed, one of the following also would be assigned:
33206 Insertion of new or replacement of permanent pacemaker with transvenous electrode(s); atrial
33207 Insertion of new or replacement of permanent pacemaker with transvenous electrode(s); ventricular
If the lead removal was performed, assign the following. If the lead was capped and a new lead was placed, do not report this code.
33244 Removal of single or dual chamber implantable defibrillator electrode(s); by transvenous extraction