A method, system, and apparatus for performing a lead condition assessment and/or a lead orientation determination associated with an implantable medical device (IMD). A first impedance is determined. The first impedance relates to the impedance relative to a first electrode and a portion of the IMD. A second impedance is determined. The second impedance relates to the impedance relative to a second electrode and the portion of the IMD. The first impedance is compared with the second impedance to determine an impedance difference. A determination is made whether the impedance difference is outside a predetermined tolerance range. Furthermore, artifact measured during impedance measurements or test pulses may be compared to assess lead orientation. An indication of a lead condition error is provided in response to determining that the impedance difference is outside the predetermined tolerance range.