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The procedure described by CPT® Code 33231 involves the insertion of an implantable defibrillator pulse generator, specifically in patients who already have multiple 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, followed by closure of the pocket. This procedure is specifically coded as 33231 when it involves the insertion of the pulse generator with multiple existing leads, distinguishing it from similar procedures that may involve fewer leads.
© Copyright 2025 Coding Ahead. All rights reserved.
The insertion of an implantable defibrillator pulse generator, as described by CPT® Code 33231, is indicated for patients who have existing multiple 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 with existing multiple leads involves several critical steps to ensure proper placement and functionality of the device.
Post-procedure care for patients who have undergone the insertion of an implantable defibrillator pulse generator includes monitoring for any immediate complications such as infection, bleeding, or device malfunction. Patients are typically advised to avoid strenuous activities and heavy lifting for a specified period to allow for proper healing of the incision site. Follow-up appointments are essential to assess the functionality of the device and to ensure that the leads are properly positioned and operational. Additionally, patients may receive instructions on how to care for the incision site and recognize signs of potential complications that may require medical attention.
| Short Descr | INSRT PULSE GEN W/MULT LEADS | Medium Descr | INSJ IMPLNTBL DEFIB PULSE GEN W/EXIST MULTILEADS | Long Descr | Insertion of implantable defibrillator pulse generator only; with existing multiple 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) |
| 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). | 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. | 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 | CC | Procedure code change (use 'cc' when the procedure code submitted was changed either for administrative reasons or because an incorrect code was filed) | GC | This service has been performed in part by a resident under the direction of a teaching physician | Q0 | Investigational clinical service provided in a clinical research study that is in an approved clinical research study | XE | Separate encounter, a service that is distinct because it occurred during a separate encounter | 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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| 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 |
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