# 93458, 33210, 36140



## amym (Jan 17, 2012)

Our physician performed a left heart cath 93458 same day as a Temporary Pacemaker Placement 33210 and Arterial Line 36140.  According to the NCCI edit, Temporary Pacemaker and Arterial Line are all bundled into the CATH 93458.  

Under what circumstances would it be appropriate to add a -59 modifier to the pacemaker and the arterial line or are there no exceptions to the rule?


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## dimmitta (Jan 18, 2012)

The only circumstance I can think of where I would bill these on same day was if the Temp pacer and line were placed same day but in a different operative session. Such as, LHC was performed and patient went to recovery room only to have to be brought back into op room due to some complication for placement of pacer/arterial line.


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## Jim Pawloski (Jan 18, 2012)

amym said:


> Our physician performed a left heart cath 93458 same day as a Temporary Pacemaker Placement 33210 and Arterial Line 36140.  According to the NCCI edit, Temporary Pacemaker and Arterial Line are all bundled into the CATH 93458.
> 
> Under what circumstances would it be appropriate to add a -59 modifier to the pacemaker and the arterial line or are there no exceptions to the rule?



The arterial line is bundled into the heart cath.  You are in the arterial system to be able to perform a heart cath., so 36140 is out.  The only time that an arterial line would be placed would be for general anesthesia, but the anesthesia charge gets that service.
The venous pacemaker can be coded if the patient came into the cath lab in a heart block, and needed pacing.  A pacemaker placed for rt coronary intervention is bundled into the intervention.
Hope that helps,
Jim Pawloski, CIRCC, R.T. (CV)


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## jewlz0879 (Jan 30, 2012)

Jim Pawloski said:


> The arterial line is bundled into the heart cath.  You are in the arterial system to be able to perform a heart cath., so 36140 is out.  The only time that an arterial line would be placed would be for general anesthesia, but the anesthesia charge gets that service.
> The venous pacemaker can be coded if the patient came into the cath lab in a heart block, and needed pacing.  A pacemaker placed for rt coronary intervention is bundled into the intervention.
> Hope that helps,
> Jim Pawloski, CIRCC, R.T. (CV)




Jim, 

What if the patient presents severely bradycardic; hr 25-30 range and required emergent PM during cath? Can I bill the 33210 with 59 in this case? Thanks!


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## KimberlyAFloyd (Jan 30, 2012)

What I have in my reference guide is:

27. If the patient presents with symptomatic bradycardia (e.g., in ER), do code separately for a temporary pacemaker placed prior to diagnostic and/or therapeutic cardiac catheterization.

28. Do not code for temporary pacemaker placement when placed to prevent or treat bradyarrhythmias induced by the coronary intervention (e.g., right coronary atherectomy has a high likelihood of inducing cardiac arrhythmias, so the physician may prophylactically place a temporary pacemaker). This is a bundled component of the intervention and is not separately billable. If a temporary pacemaker was placed because the arrhythmia was caused by this intervention, it remains bundled and not separately billable.

I just had this issue the other day and this helped me.  

Good luck,
Kim Floyd, CPC


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## Jim Pawloski (Jan 30, 2012)

KimberlyAFloyd said:


> What I have in my reference guide is:
> 
> 27. If the patient presents with symptomatic bradycardia (e.g., in ER), do code separately for a temporary pacemaker placed prior to diagnostic and/or therapeutic cardiac catheterization.
> 
> ...



I agree with you Kim, except that I billed for a temporary pacemaker when a right heart cath cause an arrythmia.  No intervention was done.
Thanks,
Jim Pawloski


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## theresa.dix@tennova.com (Jan 31, 2012)

Jim Pawloski said:


> I agree with you Kim, except that I billed for a temporary pacemaker when a right heart cath cause an arrythmia.  No intervention was done.
> Thanks,
> Jim Pawloski


Jim,
 I agree with you!


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