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The CPT® Code 33226 refers to the procedure of repositioning a previously implanted cardiac venous system electrode, specifically for left ventricular pacing. This procedure includes the removal, insertion, and/or replacement of an existing generator. The primary goal of this intervention is to ensure that the pacing electrode, which is crucial for cardiac resynchronization therapy (CRT), is correctly positioned within the cardiac venous system to optimize heart function in patients suffering from advanced heart failure. CRT is a specialized treatment aimed at improving the synchronization of the heart's contractions, particularly in cases where there is a delay due to conditions such as bundle branch block. By repositioning the electrode, the physician can enhance the effectiveness of the pacing therapy, allowing for better coordination between the right and left ventricles, which is essential for efficient cardiac output. This procedure may involve the use of fluoroscopic guidance to accurately reposition the electrode within the coronary sinus vein, ensuring that it is optimally placed for effective pacing.
© Copyright 2025 Coding Ahead. All rights reserved.
The procedure described by CPT® Code 33226 is indicated for patients with advanced heart failure who require cardiac resynchronization therapy (CRT) due to issues such as asynchronous contraction of the heart's ventricles. Specifically, it is performed when there is a need to reposition a malpositioned pacing electrode within the cardiac venous system to improve the synchronization of ventricular contractions. This is particularly relevant for patients who have a bundle branch block, which can lead to delayed contraction between the right and left ventricles, thereby compromising cardiac efficiency.
The procedure for CPT® Code 33226 involves several critical steps to ensure the successful repositioning of the pacing electrode. Initially, the physician will assess the current position of the pacing electrode and determine the need for repositioning. Following this assessment, the existing pacemaker or implantable defibrillator generator's skin pocket is opened to access the leads. If the generator requires replacement, the atrial and/or ventricular electrodes are disconnected from the old generator, which is then removed. An incision is made in the upper chest to expose the cephalic, subclavian, or jugular vein, allowing for the insertion of a sheath into the selected vessel. Under fluoroscopic guidance, the pacing wire is advanced into the coronary sinus vein, where the lead's functionality is tested to ensure it is operating correctly. After confirming that the new lead is functioning as intended, it is connected to either the new or existing pulse generator. The pulse generator is then tested to verify its operation. Once all components are confirmed to be working properly, the pulse generator is placed back into the pocket, secured to the underlying tissue, and the incision is sutured closed.
After the repositioning procedure is completed, patients are typically monitored for any immediate complications related to the surgery. Post-procedure care may include pain management, monitoring for signs of infection at the incision site, and ensuring that the pacing system is functioning correctly. Patients may be advised on activity restrictions to allow for proper healing of the incision site. Follow-up appointments are essential to assess the effectiveness of the repositioned electrode and to make any necessary adjustments to the pacing settings. Additionally, patients should be educated on recognizing any potential complications, such as changes in heart rhythm or signs of infection, and when to seek medical attention.
| Short Descr | REPOSITION L VENTRIC LEAD | Medium Descr | RPSG PREV IMPLTED CAR VEN SYS L VENTR ELTRD | Long Descr | Repositioning of previously implanted cardiac venous system (left ventricular) electrode (including removal, insertion and/or replacement of existing generator) | Status Code | Active Code | Global Days | 000 - Endoscopic or Minor Procedure | PC/TC Indicator (26, TC) | 0 - Physician Service Code | Multiple Procedures (51) | 2 - Standard payment adjustment rules for multiple procedures apply. | Bilateral Surgery (50) | 0 - 150% payment adjustment for bilateral procedures does NOT apply. | Physician Supervisions | 09 - Concept does not apply. | Assistant Surgeon (80, 82) | 1 - Statutory payment restriction for assistants at surgery applies to this procedure... | Co-Surgeons (62) | 0 - Co-surgeons not permitted for this procedure. | Team Surgery (66) | 0 - Team surgeons not permitted for this procedure. | Diagnostic Imaging Family | 99 - Concept Does Not Apply | APC Status Indicator | Hospital Part B services paid through a comprehensive APC | ASC Payment Indicator | Device-intensive procedure added to ASC list in CY 2008 or later; paid at adjusted rate. | Type of Service (TOS) | 2 - Surgery | Berenson-Eggers TOS (BETOS) | P2B - Major procedure, cardiovascular-Aneurysm repair | MUE | 1 | CCS Clinical Classification | 48 - Insertion, revision, replacement, removal of cardiac pacemaker or cardioverter/defibrillator |
| 22 | Increased procedural services: when the work required to provide a service is substantially greater than typically required, it may be identified by adding modifier 22 to the usual procedure code. documentation must support the substantial additional work and the reason for the additional work (ie, increased intensity, time, technical difficulty of procedure, severity of patient's condition, physical and mental effort required). note: this modifier should not be appended to an e/m service. | 51 | Multiple procedures: when multiple procedures, other than e/m services, physical medicine and rehabilitation services or provision of supplies (eg, vaccines), are performed at the same session by the same individual, the primary procedure or service may be reported as listed. the additional procedure(s) or service(s) may be identified by appending modifier 51 to the additional procedure or service code(s). note: this modifier should not be appended to designated "add-on" codes (see appendix d). | 52 | Reduced services: under certain circumstances a service or procedure is partially reduced or eliminated at the discretion of the physician or other qualified health care professional. under these circumstances the service provided can be identified by its usual procedure number and the addition of modifier 52, signifying that the service is reduced. this provides a means of reporting reduced services without disturbing the identification of the basic service. note: for hospital outpatient reporting of a previously scheduled procedure/service that is partially reduced or cancelled as a result of extenuating circumstances or those that threaten the well-being of the patient prior to or after administration of anesthesia, see modifiers 73 and 74 (see modifiers approved for asc hospital outpatient use). | 53 | Discontinued procedure: under certain circumstances, the physician or other qualified health care professional may elect to terminate a surgical or diagnostic procedure. due to extenuating circumstances or those that threaten the well being of the patient, it may be necessary to indicate that a surgical or diagnostic procedure was started but discontinued. this circumstance may be reported by adding modifier 53 to the code reported by the individual for the discontinued procedure. note: this modifier is not used to report the elective cancellation of a procedure prior to the patient's anesthesia induction and/or surgical preparation in the operating suite. for outpatient hospital/ambulatory surgery center (asc) reporting of a previously scheduled procedure/service that is partially reduced or cancelled as a result of extenuating circumstances or those that threaten the well being of the patient prior to or after administration of anesthesia, see modifiers 73 and 74 (see modifiers approved for asc hospital outpatient use). | 58 | Staged or related procedure or service by the same physician or other qualified health care professional during the postoperative period: it may be necessary to indicate that the performance of a procedure or service during the postoperative period was: (a) planned or anticipated (staged); (b) more extensive than the original procedure; or (c) for therapy following a surgical procedure. this circumstance may be reported by adding modifier 58 to the staged or related procedure. note: for treatment of a problem that requires a return to the operating/procedure room (eg, unanticipated clinical condition), see modifier 78. | 59 | Distinct procedural service: under certain circumstances, it may be necessary to indicate that a procedure or service was distinct or independent from other non-e/m services performed on the same day. modifier 59 is used to identify procedures/services, other than e/m services, that are not normally reported together, but are appropriate under the circumstances. documentation must support a different session, different procedure or surgery, different site or organ system, separate incision/excision, separate lesion, or separate injury (or area of injury in extensive injuries) not ordinarily encountered or performed on the same day by the same individual. however, when another already established modifier is appropriate it should be used rather than modifier 59. only if no more descriptive modifier is available, and the use of modifier 59 best explains the circumstances, should modifier 59 be used. note: modifier 59 should not be appended to an e/m service. to report a separate and distinct e/m service with a non-e/m service performed on the same date, see modifier 25. | 62 | Two surgeons: when 2 surgeons work together as primary surgeons performing distinct part(s) of a procedure, each surgeon should report his/her distinct operative work by adding modifier 62 to the procedure code and any associated add-on code(s) for that procedure as long as both surgeons continue to work together as primary surgeons. each surgeon should report the co-surgery once using the same procedure code. if additional procedure(s) (including add-on procedure(s) are performed during the same surgical session, separate code(s) may also be reported with modifier 62 added. note: if a co-surgeon acts as an assistant in the performance of additional procedure(s), other than those reported with the modifier 62, during the same surgical session, those services may be reported using separate procedure code(s) with modifier 80 or modifier 82 added, as appropriate. | 76 | Repeat procedure or service by same physician or other qualified health care professional: it may be necessary to indicate that a procedure or service was repeated by the same physician or other qualified health care professional subsequent to the original procedure or service. this circumstance may be reported by adding modifier 76 to the repeated procedure or service. note: this modifier should not be appended to an e/m service. | 78 | Unplanned return to the operating/procedure room by the same physician or other qualified health care professional following initial procedure for a related procedure during the postoperative period: it may be necessary to indicate that another procedure was performed during the postoperative period of the initial procedure (unplanned procedure following initial procedure). when this procedure is related to the first, and requires the use of an operating/procedure room, it may be reported by adding modifier 78 to the related procedure. (for repeat procedures, see modifier 76.) | 79 | Unrelated procedure or service by the same physician or other qualified health care professional during the postoperative period: the individual may need to indicate that the performance of a procedure or service during the postoperative period was unrelated to the original procedure. this circumstance may be reported by using modifier 79. (for repeat procedures on the same day, see modifier 76.) | AO | Alternate payment method declined by provider of service | AQ | Physician providing a service in an unlisted health professional shortage area (hpsa) | GC | This service has been performed in part by a resident under the direction of a teaching physician | KX | Requirements specified in the medical policy have been met | XS | Separate structure, a service that is distinct because it was performed on a separate organ/structure | XU | Unusual non-overlapping service, the use of a service that is distinct because it does not overlap usual components of the main service |
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| 2012-01-01 | Changed | Description Changed |
| 2003-01-01 | Added | First appearance in code book in 2003. |
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