2025 CPT code 33225
(Active) Effective Date: N/A Revision Date: N/A Cardiology - Pacemaker or Implantable Defibrillator Procedures Surgery Feed
Insertion of a left ventricular pacing electrode via the cardiac venous system during the implantation of a pacemaker or implantable cardioverter-defibrillator (ICD).
Modifiers may be applicable depending on the circumstances of the procedure.Consult the CPT manual and local payer guidelines for appropriate modifier use. For example, modifier 59 (distinct procedural service) might be needed if the left ventricular lead insertion is distinctly separate from the other parts of the procedure.Modifier 52 (reduced services) might apply if the procedure is not fully completed due to unforeseen complications. Always refer to current guidelines.
Medical necessity for code 33225 is established by the presence of documented indications such as sick sinus syndrome, atrioventricular block, or heart failure with documented dyssynchrony demonstrably benefiting from cardiac resynchronization therapy (CRT).Supporting documentation should clearly justify the need for the additional left ventricular lead.
The cardiologist or cardiac electrophysiologist is responsible for performing this procedure, which requires expertise in cardiac pacing and device implantation.This includes patient assessment, pre-procedural planning, lead placement under fluoroscopic guidance, ensuring proper lead positioning, attaching the lead to the pulse generator, and post-procedural care.
- Surgery
- Surgical Procedures on the Cardiovascular System > Pacemaker or Implantable Defibrillator Procedures
In simple words: This medical code describes adding a special wire (electrode) to a heart device (pacemaker or defibrillator) to help the left side of the heart beat better with the right.This is done during the same procedure as putting in or replacing the main heart device.
This CPT code, 33225, represents the insertion of a pacing electrode into the left ventricle through the cardiac venous system. This procedure is performed concurrently with the implantation or replacement of a pacemaker or implantable cardioverter-defibrillator (ICD) pulse generator.It's considered an add-on code and requires a primary procedure code for appropriate billing. The insertion involves the introduction of the electrode lead through a vein (typically the internal jugular or subclavian vein) and its advancement under fluoroscopic guidance to the left ventricle.Secure placement over the left ventricle is verified, following which the lead is attached to the device's pulse generator.The procedure aims to upgrade the system to a dual or biventricular configuration, improving cardiac synchrony, particularly beneficial in cases of sick sinus syndrome, atrioventricular block, or both.
Example 1: A patient with a history of sick sinus syndrome and a single-chamber pacemaker requires upgrade to a dual-chamber system for improved cardiac output. The cardiologist implants a new dual-chamber pulse generator and uses code 33225 to bill for the addition of the left ventricular pacing lead., A patient receives a new implantable cardioverter-defibrillator (ICD) with biventricular pacing capability. Code 33225 is used to report the insertion of the left ventricular lead in conjunction with the ICD implantation., During a pacemaker replacement, it is determined that the patient requires biventricular pacing for optimal cardiac function. The existing right-sided leads are removed and replaced with new leads. Code 33225 is reported alongside the codes for pulse generator removal and replacement and the insertion of the right-sided leads.
Thorough patient history and physical examination notes, including details on the indication for biventricular pacing.Pre-operative imaging studies (e.g., echocardiogram) to assess cardiac function.Intraoperative fluoroscopic images demonstrating lead placement. Post-operative device interrogation reports to verify appropriate functionality.
** This code is only reported when adding a left ventricular lead during the implantation or replacement of a pacemaker or ICD.It does not include the costs associated with the initial device implantation or other additional procedures (unless specifically indicated and reported with separate codes).
- Payment Status: Active
- Modifier TC rule: A technical component (TC) modifier may not be applicable, as this add-on code is usually performed as part of a larger procedure.Consult the CPT manual and payer guidelines for specifics.
- Specialties:Cardiology, Cardiac Electrophysiology
- Place of Service:Inpatient Hospital, Outpatient Hospital, Ambulatory Surgical Center