In simple words: The doctor inserts or replaces a pacemaker and implants electrodes (leads) into both the upper right and lower right chambers of your heart. This helps your heart beat regularly.

This code describes a procedure where a permanent dual-chamber pacemaker system is inserted or replaced. It involves placing leads into both the right atrium and the right ventricle transvenously. The procedure includes the insertion of the pulse generator into a subcutaneous pocket, typically in the subclavicular or abdominal area.

Example 1: A patient with symptomatic bradycardia and atrioventricular block undergoes implantation of a dual-chamber pacemaker system with leads placed in the right atrium and right ventricle., A patient with a failing single-chamber pacemaker requires upgrading to a dual-chamber system. The old generator and lead are removed, and a new dual-chamber system is implanted., A patient with an infected pacemaker pocket requires system replacement. The infected generator and leads are removed, the pocket is cleaned, and a new dual-chamber system is implanted in a new pocket location.

Documentation should include the medical necessity for the procedure, such as diagnostic tests (ECG, Holter monitor) showing bradycardia or heart block. Operative report details the type of pacemaker system implanted, lead placement (atrial and ventricular), and any complications. Pre- and post-operative diagnoses and programming of the device should be documented.

** CPT code 33208 represents the complete system replacement or insertion, including both the pulse generator and the leads. For generator replacement only, use codes 33227, 33228, or 33229. For lead insertion without generator replacement, use codes 33216 or 33217.