Q & A with Dr. Z: Aborted Upgrade of Dual PPM to Bi-V ICD

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

Question:
“Patient brought to ASC cath lab, prepped, draped and local anesthesia was administered. The left axillary vein was cannulated using fluoroscopic landmarks. 2 guidewires were inserted through the needle to establish IV access. A micropuncture needle was used & the micro sheath was advanced into the vessel and used for electrode placement. The left infraclavicular pocket was opened with an incision over the previous one. The pocket appeared normal. Patient developed progressive SOB after being placed on the table for the procedure with 02 saturation dropping to low 90’s despite 02 supplement. Then the patient was noted to be in acute respiratory distress and the procedure was aborted. The left subclavian wires were removed. The pocket was irrigated with sterile H2O solution, hemostasis was obtained with electrocautery and the pocket was closed with 2-0 and 4-0 vicryl.”

Do I code the planned procedure (33349 & 33225) with a -53 modifier or what would I be able to code, since nothing was completed with either the leads or the generator?

Answer:
We would not report codes 33225 and 33249, as they were not attempted really. There is mention of an electrode placement, so we would go with 33216-53 or -74 for facility.