I have a patient who received an implantable cardioverter-defibrillator (ICD) dual-chamber device from company A. During the defibrillation threshold testing (DFT) phase, the device would not convert the patient from ventricular fibrillation, and rescue shocks were performed. The patient returned the following day and a new ICD generator from company B was inserted. This device has a higher joule output that will allow the patient to be converted from the arrhythmia.

Can I assign the following CPT® code for an ICD generator change?

33263 Removal of implantable defibrillator pulse generator with replacement of implantable defibrillator pulse generator; dual lead system


Code 33263 would be the correct code when the existing dual-chamber ICD generator was removed on a separate day from the initial insertion date and inserted and attached to the existing right atrium (RA) and right ventricle (RV) leads.

For professional fee billing, assign the following modifier since this is within the global period (90 days):

Modifier -78 Unplanned return to the operating/procedure room by the same physician or other qualified health care professional following initial procedure for a related procedure during the postoperative period

For hospital billing, the modifier -78 would not be needed as this is construed as a separate date of service and the global period does not apply.

CPT® is a registered trademark of the American Medical Association.


CPT® copyright 2021 American Medical Association (AMA). All rights reserved.

Fee schedules, relative value units, conversion factors and/or related components are not assigned by the AMA, are not part of CPT, and the AMA is not recommending their use. The AMA does not directly or indirectly practice medicine or dispense medical services. The AMA assumes no liability for data contained or not contained herein.

CPT is a registered trademark of the American Medical Association.