Summary & Overview
CPT 33235: Pacemaker Lead Removal and Generator Pocket Exploration
CPT code 33235 represents surgical removal of two pacemaker leads through an incision to open the device pocket and extract the leads. This procedural code captures a common cardiac device intervention that can be performed in inpatient, outpatient surgical, or ambulatory surgery center settings. Nationally, procedures involving cardiac implantable electronic devices are clinically significant due to rising device prevalence, infection risk, and implications for perioperative and long-term cardiac care.
Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of clinical context for lead removal, typical sites of service, common billing modifiers and procedural relationships (where provided), and the types of benchmarks and policy updates that affect coding and reimbursement for device procedures. The publication outlines what to expect in payer coverage patterns, common coding pitfalls, and areas where policy changes or payer guidelines commonly influence authorization and documentation requirements.
This summary equips clinicians, billing professionals, and policy stakeholders with the essential background on CPT code 33235, clarifies the procedure it represents, and identifies the primary topics addressed in the full publication, including benchmarking, payer guidance, and clinical coding context.
Billing Code Overview
CPT code 33235 describes a surgical procedure in which the provider opens a pacemaker pocket, disconnects, and removes two electrode leads from the generator. This procedure involves an incision to access the implanted pulse generator and the removal of leads that connect the generator to the heart.
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Service type: Lead removal and generator pocket exploration
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Typical site of service: Hospital inpatient or outpatient surgical unit, or ambulatory surgery center
Clinical & Coding Specifications
Clinical Context
A 72-year-old male with a previously implanted dual-lead pacemaker presents for elective removal of the generator and extraction of two transvenous leads due to device infection of the pocket with erythema, drainage, and positive blood cultures. Preoperative evaluation includes device interrogation, chest radiograph to confirm lead position, review of anticoagulation, and informed consent discussing risks of lead removal. In the operating room or cardiac catheterization lab under monitored anesthesia care or general anesthesia, the provider makes an incision over the existing pacemaker pocket, opens the pocket, disconnects the generator from the two leads, and removes both leads through the pocket tract. Hemostasis is achieved, the pocket is irrigated, and a decision is made to place a new device—either in a contralateral pocket or after an interval—based on infection status. Postoperative management includes wound care, antibiotics as indicated, device reimplant timing planning, and monitoring for complications such as lead fracture, bleeding, pneumothorax, or cardiac tamponade.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
00 | Standard – no modifier | Use when no additional reporting modifier is required and the service is reported normally |
52 |