His Bundle Lead Upgrade

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by David Zielske, MD, CIRCC, COC, CCVTC, CCC, CCS, RCC

Patient with dual chamber pacemaker upgrade to a Bi-V pacemaker. Generator change and His Bundle lead implanted in RA (Basal Septum). Retained RV and RA leads; patient with 2 RA and 1 RV Lead. Would this be charged as 33229 with unlisted code or just 33229?

His lead is coded as either a RA lead if in atrium or RV lead if passes through valve to ventricle. A His lead is not 33224 or 33225 as it is not placed in the cardiac venous system, i.e., coronary sinus. When a new generator and a new lead is placed, we code a complete procedure based on the chamber the lead(s) is (are) placed. Codes 3320633208 include lead(s) so there is no additional code for placement of a His lead currently. We would add code 33233 for removal of the old generator. Hopefully in the future specific His lead codes will be developed. We will keep you informed should this happen.

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About the Author

David Zielske is founder and President of ZHealth Publishing and primary author and editor of ZHealth publications. Dr. Z practiced as an interventional radiologist and has over twenty years experience as a coding reviewer and coding expert. He is Board Certified in Radiology and has functioned as an independent interventional radiology, vascular surgery, and cardiovascular coding consultant to a variety of physician groups and hospital providers across the country. He also served as an instructor for over 200 coding seminars.

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