# Permanent pacemaker with Temp pacemaker?



## Patricia L Diaz (Feb 10, 2010)

Please help me out w/this scenerio...

This is a 90yr old female was admitted in February 2009 with complete heart block and had a temporary and then subsequently permanent pacemaker implantation done. She did well until April 7,2009 when whe was found to have intermittent loss of pacemaker capture and required a temporary pacemaker because she was completely pacemaker dependent.  Without the pacemaker she had no heartbeat.  After temporary pacemaker implantation her permanent pacemaker lead was repositioned and a good position was obtained.  she was pacing and sensing normally and had a good threshold, but then she started to have episode of cough and her pacemaker lead again moved slightly and she again started to have intermittent loss of capture and, in spite of changing threshold and pacing voltage, she was not able to have normal pacing.  Because of this and her being completely dependent upon the pacemaker, she had to have the procedure repeated again under local anesthesia because the patient was very restless and it was impossible to do it without anesthesia.  As she was totally dependent upon the pacemaker, it was unsafe to move the permanent pacemaker lead without the risk of cardiac arrest if she did not have the support of a temporary pacemaker.  So she had  to have another temporary pacemaker implant done and had successfully reposition of the lead to a different location and she was pacing and sensing normally and had no further loss of capture or sensing during her hospitalization. Because of her advanced age and thin myocardium she had this problem.

ok...initially I reported...

33210 (paid)                33210/76 (not paid)
33215 (not paid)           33215/76 (paid)
71090 (paid)                71090/76 (not paid)

so...how do I get proc not paid to be paid...Am I doing something wrong?? or leaving something out?? This is the first time that I have had to file this type of claim...Please help...


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## deeva456 (Feb 12, 2010)

Hi, 

I'll be more than happy to help you code these. could you separate out the dates the procedures were done?  That way I would know what modifiers would be needed. 

Thanks, Dolores CCC-CPC


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## Patricia L Diaz (Feb 15, 2010)

Dolores,

The original pacemaker was implanted 02/25/09...then in 04/09/09 one of the leads moved and caused her to by bradycardic...w/out the pacemaker she had no heartbeat so a temp had to be set up before new placement of the old lead could be done...in short...temporaty pacemaker implantation with permanent pacemaker lead revision all done on the same dos 04/09/09...Thanks for taking time out of you day to help me...I really appreciate it!


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## deeva456 (Feb 15, 2010)

Hi,

I'm happy to help.... 

Here is how these procedures should have been coded:

2/25/09;  33125, 33210-59, 71090-26  DX: 426.0

4/09/09: 33215-78, 71090-26-78 Dx: 996.01, V45.01
             33210-59-78 Dx: 427.81, 426.0

If you rebill with these modifiers and dx, you should get paid. However, since the insurance payer did not pay the first 33215 you going to have to appeal this with reports and a good explanation. 

good luck!!

Dolores, CPC - CCC


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## Patricia L Diaz (Feb 16, 2010)

Thanks Dolores!!!


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## deeva456 (Feb 16, 2010)

Hi Patricia,

I made one minor error....I realized it late last night, I was "thrown" by using 33215 twice.

On 2/5/09 if this was the first pacemaker implanted 33215 is the wrong code. Depending if a single or dual lead pacemaker was inplanted you would use 33206, 33207 or 33208 and 71090-26, 33210-59.

Sorry about the error.

Dolores, CPC-CCC


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