© Copyright 2025 American Medical Association. All rights reserved.
The procedure described by CPT® Code 33230 involves the insertion of an implantable defibrillator pulse generator, specifically in patients who already have dual leads in place. An implantable cardioverter-defibrillator (AICD or ICD) is a sophisticated medical device designed to continuously monitor the heart's electrical activity. It plays a critical role in managing life-threatening arrhythmias by providing various therapeutic interventions. These include anti-tachycardia pacing, which helps to prevent rapid and irregular heart rhythms; backup pacing, which ensures the heart maintains a healthy rhythm; cardioversion, which uses a mild electrical shock to restore a normal heart rhythm; and defibrillation, which delivers a stronger shock to correct dangerously abnormal rhythms or to restart the heart during cardiac arrest. During the procedure, the physician makes an incision, typically located in the left pectoral region, to create a subcutaneous pocket where the pulse generator will be placed. The existing leads are then connected to the pulse generator, and the functionality of the device is tested to ensure proper operation. Once confirmed, the pulse generator is securely positioned within the pocket and sutured to the underlying tissue, after which the incision site is closed. This procedure is specifically coded as 33230 when performed with existing dual leads, distinguishing it from other codes that may apply to different lead configurations.
© Copyright 2025 Coding Ahead. All rights reserved.
The insertion of an implantable defibrillator pulse generator, as described by CPT® Code 33230, is indicated for patients who have existing dual leads and require the implantation of a new pulse generator. This procedure is typically performed in cases where the patient has a history of life-threatening arrhythmias or conditions that predispose them to such events, necessitating continuous monitoring and intervention to maintain a stable heart rhythm.
The procedure for the insertion of an implantable defibrillator pulse generator involves several critical steps to ensure proper placement and functionality of the device. Initially, the physician prepares the patient for surgery, which includes administering anesthesia and ensuring a sterile environment. Following this, an incision is made in the skin, typically located in the left pectoral region, to access the area where the pulse generator will be implanted. Next, a subcutaneous pocket is created to house the pulse generator securely. The existing dual leads, which have been previously implanted, are then carefully connected to the new pulse generator. It is essential to test the generator at this stage to confirm that both the leads and the generator are functioning correctly. This testing ensures that the device is ready to monitor the heart's electrical activity and provide necessary interventions. Once the functionality is verified, the pulse generator is placed into the prepared pocket, and it is sutured to the underlying tissue to secure it in position. Finally, the incision site is closed with sutures, completing the procedure. This meticulous approach ensures that the implantable defibrillator is properly positioned and ready to perform its life-saving functions.
After the insertion of the implantable defibrillator pulse generator, patients typically require monitoring to assess the immediate outcomes of the procedure. Post-procedure care may include observation for any signs of complications, such as infection or improper device function. Patients are often advised to limit physical activity for a specified period to allow for proper healing of the incision site. Follow-up appointments are essential to evaluate the device's performance and to make any necessary adjustments. Additionally, patients may receive education on recognizing symptoms that warrant immediate medical attention, such as unusual heart rhythms or signs of infection at the surgical site.
| Short Descr | INSRT PULSE GEN W/DUAL LEADS | Medium Descr | INSJ IMPLNTBL DEFIB PULSE GEN W/EXIST DUAL LEADS | Long Descr | Insertion of implantable defibrillator pulse generator only; with existing dual leads | Status Code | Active Code | Global Days | 090 - Major Surgery | 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) | P2E - Major procedure, cardiovascular-Pacemaker insertion | MUE | 1 | CCS Clinical Classification | 48 - Insertion, revision, replacement, removal of cardiac pacemaker or cardioverter/defibrillator |
This is a primary code that can be used with these additional add-on codes.
| 33225 | Addon Code MPFS Status: Active Code APC N ASC N1 Physician Quality Reporting PUB 100 CPT Assistant Article Insertion of pacing electrode, cardiac venous system, for left ventricular pacing, at time of insertion of implantable defibrillator or pacemaker pulse generator (eg, for upgrade to dual chamber system) (List separately in addition to code for primary procedure) |
| 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). | 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. | 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.) | CR | Catastrophe/disaster related | GC | This service has been performed in part by a resident under the direction of a teaching physician | GW | Service not related to the hospice patient's terminal condition | KX | Requirements specified in the medical policy have been met | LT | Left side (used to identify procedures performed on the left side of the body) | Q6 | Service furnished under a fee-for-time compensation arrangement by a substitute physician or by a substitute physical therapist furnishing outpatient physical therapy services in a health professional shortage area, a medically underserved area, or a rural area |
|
Date
|
Action
|
Notes
|
|---|---|---|
| 2017-01-01 | Changed | Moderate (Conscious) Sedation flag removed. See new Moderate Sedation category. |
| 2015-01-01 | Changed | Description Changed |
| 2012-01-01 | Added | Added |
Get instant expert-level medical coding assistance.