2025 CPT code 33249
(Active) Effective Date: N/A Revision Date: N/A Cardiovascular Surgery - Surgical Procedures on the Cardiovascular System Surgery Feed
Insertion or replacement of a permanent implantable defibrillator system with transvenous leads; single or dual chamber.
Modifiers may be applicable depending on the circumstances of the procedure.Consult the CPT manual for appropriate modifier usage.
Medical necessity for ICD implantation is established through clinical documentation demonstrating increased risk of sudden cardiac death (e.g., history of myocardial infarction, cardiomyopathy, arrhythmias).The documentation should support the chosen system (single vs. dual chamber) based on individual patient needs.
The physician is responsible for pre-operative assessment, preparation of the patient, creating the incision, implanting or replacing the defibrillator system, including lead placement and connection, testing device functionality, hemostasis, and wound closure.Post-operative care is not included.
In simple words: This code covers placing or replacing a device in the chest that helps regulate a heart's rhythm.The device may use one or two wires (leads) connected to the heart to monitor and correct irregular heartbeats with electric shocks when necessary.
This CPT code encompasses the insertion or replacement of a permanent implantable cardioverter-defibrillator (ICD) system.The procedure includes the placement of transvenous leads (single or dual chamber) and may involve the removal and replacement of existing components.Fluoroscopic guidance, radiological supervision and interpretation are inherent to the code and not separately reported.Specific lead placement (e.g., right atrial, right ventricular) is implied but not explicitly coded in 33249.
Example 1: A 65-year-old male patient with a history of myocardial infarction and reduced ejection fraction undergoes implantation of a dual-chamber ICD system due to high risk of sudden cardiac death., A 72-year-old female patient with an existing single-chamber ICD experiences device malfunction.The physician performs removal of the old device and implantation of a new dual-chamber ICD system., A 48-year-old patient with congenital long QT syndrome requires implantation of a single-chamber ICD for primary prevention of sudden cardiac death.
Comprehensive history and physical examination, electrocardiogram (ECG) findings demonstrating the need for ICD, imaging studies (e.g., chest x-ray) to confirm lead placement, device interrogation reports demonstrating proper function.
** This code does not include the separate reporting ofbody surface-activation mapping (0695T) which might be used to optimize the electrical synchrony of a biventricular pacing or biventricular pacing-defibrillator system.
- Payment Status: Active
- Modifier TC rule: Not applicable.
- Specialties:Cardiology, Cardiac Surgery, Electrophysiology
- Place of Service:Inpatient Hospital, Outpatient Hospital, Ambulatory Surgical Center