2025 CPT code 33224
(Active) Effective Date: N/A Revision Date: N/A Surgery - Pacemaker and Implantable Defibrillator Procedures Cardiovascular System Feed
Insertion of a pacing electrode into the cardiac venous system for left ventricular pacing, with attachment to a previously placed pacemaker or implantable cardioverter-defibrillator pulse generator.
Modifiers may be applicable depending on the circumstances of the procedure.Consult the most recent CPT guidelines and NCCI edits for appropriate modifier usage.
Medical necessity is established by evidence of symptomatic heart failure or documented left bundle branch block with symptoms despite optimal medical management.The procedure is justified by the need to improve cardiac synchrony and reduce symptoms of heart failure.
The physician is responsible for the proper placement of the lead, ensuring correct positioning within the left ventricle under fluoroscopic guidance.They are also responsible for attaching the lead to the generator, managing any complications, and performing any necessary pocket revision or generator replacement.
In simple words: The doctor inserts an extra wire (electrode) through a vein into the heart's left ventricle to help it beat in sync with the right. This is connected to an existing device (pacemaker or defibrillator), potentially also replacing the device itself if needed. This helps patients with heart failure who need their heart's ventricles to work together.
This procedure involves the insertion of a pacing electrode lead via a vein (usually the internal jugular or subclavian vein) into the left ventricle under fluoroscopic guidance.The electrode is then attached to an existing pacemaker or implantable cardioverter-defibrillator (ICD) pulse generator.The procedure may also include revision of the existing pocket, removal, insertion, and/or replacement of the existing generator. This is often performed for patients at high risk of heart failure requiring biventricular pacing to improve cardiac synchrony and reduce symptoms.
Example 1: A patient with heart failure and reduced ejection fraction requires biventricular pacing to improve cardiac function.The physician performs this procedure to insert an additional lead into the left ventricle., A patient with an existing dual-chamber pacemaker experiences worsening heart failure symptoms. The physician performs this procedure to add a left ventricular lead, converting the system to a biventricular pacing system., A patient undergoing ICD implantation requires a left ventricular lead for cardiac resynchronization therapy.The physician performs this procedure during the initial ICD implant procedure.
Pre-operative assessment including patient history, physical examination, and relevant imaging studies (echocardiogram, etc.). Intra-operative documentation detailing lead placement, fluoroscopic guidance, generator manipulation (if any), and post-operative device interrogation.Post-operative assessment to ensure proper function.
** This code should only be reported when the additional left ventricular lead is placed, and it is not separately reported if the existing pulse generator is removed, inserted, or replaced as part of the same session.
- Payment Status: Active
- Modifier TC rule: Not applicable.
- Specialties:Cardiology, Cardiac Surgery
- Place of Service:Inpatient Hospital, Outpatient Hospital, Ambulatory Surgical Center