In insertion of a pacemaker system, coding for RA and RV lead implanting

Q.

A patient undergoes an initial insertion of a dual-chamber pacemaker system. A Right Atrial (RA) lead is implanted. In the Right Ventricle (RV), 2 leads are implanted – 1 at the apex and 1 at the HIS bundle. Would this be assigned only CPT^® code with 33208 since the code description contains the word “electrode(s)”? Alternatively, can Unlisted Procedure Code (i.e., UPC) 33999 be added to 33208 to represent the extra lead/extra work involved?

A.

When an RA and RV lead is placed in addition to the generator, assign CPT code 33208. If an additional RV lead is placed at the HIS for LV support, also assign CPT code 33999 as well. This additional lead is being placed usually if the left coronary sinus can’t be accessed.

The codes and full descriptions are:

33208  Insertion of new or replacement of permanent pacemaker with transvenous electrode(s); atrial and ventricular

33999  Unlisted procedure, cardiac surgery