# Temporary pacemaker during an emergent procedure



## Stultz1224 (Jul 25, 2018)

I am new to cardiology coding and need a little clarification.

The case is as follows:

PREPROCEDURE DIAGNOSIS:  Acute inferior ST segment elevation myocardial
infarction complicated by complete heart block and hypotension.

POSTPROCEDURE DIAGNOSIS:  Coronary artery disease.

PROCEDURE PERFORMED:
1.  Emergent coronary angiography.
2.  Temporary right ventricular pacemaker insertion.
3.  Emergent percutaneous transluminal coronary stenting of the mid right
coronary artery, performed in the setting of acutely occluded coronary
vessel with acute myocardial infarction (3 drug-eluting stents placed in
one coronary vessel).

INDICATIONS FOR PROCEDURE:  A  male with Parkinson's
disease, presenting with syncope, but without chest pain, but was found on
ECG to have acute inferior ST segment elevation myocardial infarction
associated with a severe complete heart block with a heart rate of 25
beats per minute and the systolic blood pressure of 80-100 mmHg.

The patient was brought emergently from the paramedics into the cardiac
catheterization lab with ongoing complete heart block and hypotension.
The right groin area was prepped and draped in the usual sterile fashion
and anesthetized locally with 1 percent Xylocaine.  The right femoral
artery and vein were punctured with modified Seldinger technique and
6-French sheaths were introduced into both vessels.  A 6-French temporary
pacemaker electrode was placed in the right ventricular apex and temporary
pacing was performed, which resulted in hemodynamic improvement.  We then
used a 6-French JR4 guide catheter to cannulate the right coronary artery.
 The left coronary artery was cannulated with a 5-French JL4 diagnostic
catheter.

I did not attach the complete case, because I didn't think the rest was necessary for my question. The temporary pacemaker was removed during this same procedure. Would I use 33210 for the temporary pacemaker as well as 92941?


----------



## JayalakshmiF (Jul 26, 2018)

Do not code temporary pacemaker as it is  removed and also it cannot be coded together with CPT 33210 and 92941.

As per CCI Edit Code 33210 is a column 2 code for 92941, These codes cannot be billed together in any circumstances.


----------

