2025 CPT code 33264
(Active) Effective Date: N/A Revision Date: N/A Cardiovascular Surgery - Pacemaker or Implantable Defibrillator Procedures Surgery Feed
Removal and replacement of an implantable defibrillator pulse generator; multiple lead system.
Modifiers may be applicable depending on the circumstances of the procedure (e.g., 59 for a distinct procedural service, 78 for unplanned return to the operating room). Consult the CPT guidelines for detailed modifier usage rules.
Medical necessity is established by documentation of generator failure, infection, or need for system upgrade.Justification should include evidence of device malfunction, infection, or the clinical benefit of upgraded features compared to the patient’s existing device.
The physician is responsible for pre-operative evaluation, obtaining informed consent, performing the surgical procedure (including incision, generator removal and replacement, lead assessment, pocket revision if needed,irrigation, closure), device programming and post-operative care.
In simple words: The doctor removes an old heart defibrillator and puts in a new one. This is for defibrillators with leads connected to multiple parts of the heart.
This CPT code represents the removal of a previously implanted defibrillator pulse generator and its replacement with a new one.This procedure specifically applies to systems with multiple leads (at least three chambers of the heart involved). The procedure involves opening the subcutaneous pocket, disconnecting the old generator, assessing lead functionality, preparing the pocket for the new generator (potentially adapting the pocket size), inserting the new generator, connecting it to the existing leads, and closing the incision.The new device is then programmed for optimal function.
Example 1: A 70-year-old patient with a three-lead implantable cardioverter-defibrillator (ICD) experiences generator failure.The ICD is explanted, and a new generator is implanted in the same pocket., A 65-year-old patient develops an infection around their three-lead ICD generator.The infected generator is removed, the pocket is debrided, and a new generator is implanted., A 55-year-old patient requires an upgrade to their existing three-lead ICD system with a new generator that offers improved features. The old generator is removed, and the new one is implanted.
Pre-operative assessment including patient history, physical exam, ECG, imaging (chest X-ray); operative report detailing the procedure, including lead integrity assessment and any complications; post-operative instructions and follow-up plan.
** This code is specifically for multiple-lead systems.Always verify the number of leads involved to ensure accurate coding. The removal and replacement of leads may be reported separately depending on if they require additional procedures.
- Payment Status: Active
- Modifier TC rule: Not applicable.
- Specialties:Cardiology, Cardiac Surgery, Electrophysiology
- Place of Service:Inpatient Hospital, Outpatient Hospital, Ambulatory Surgery Center