# Pacemaker coding



## ktden (Dec 7, 2009)

How would anyone code this?
Procedure:

Selective venography of left upper extremity.
Implantation of right atrial and right ventricular leads under fluoroscopy,
Implantation of dual chamber pacemaker.


----------



## Cyndi113 (Dec 7, 2009)

Is that the entire documentation for the procedure? That's not enough to code.


----------



## ktden (Dec 7, 2009)

*Here is the entire note.*

After inj of 2% lidocaine in the pectoral area, an incision was made and extended to pectoralis fascia using blunt dissection and a pocket was created.  Due to difficult venous access, sel venograohy of the L upper extremity was done.  Access to the axillary vein was achieved and under fluoroscopy, the R atrial lead was advanced to R atrial appendage and R ventricular lead to the R ventricular septum.  These were secured to the fascia, connected to the device and inserted into pocket and the device was sutured to the pocket.


----------



## deeva456 (Dec 7, 2009)

Hello,

The correct codes to bill are 33208 (dual chamber/lead pacemaker)  & 71090-26 ( fluoroscopy guidance) You cannot bill for the accessing the L upper extremity vessel or axillary vein, this is included in the placement of the leads/pacemaker. 

Hope this helps 

Dolores, CPC-CCC


----------



## ktden (Dec 7, 2009)

Thanks a lot. This was billed 33208, 36005-59, 75820-26,59 and I wasn't sure that was correct.  When would it be appropriate to bill 75820? During a diagnostic procedure not being interventional?


----------



## jseda (Dec 15, 2009)

33208 for dual chamber p/m (includes access/closure)
71090-26 fluoroscopy if documented


----------



## dpeoples (Dec 15, 2009)

ktden said:


> Thanks a lot. This was billed 33208, 36005-59, 75820-26,59 and I wasn't sure that was correct.  When would it be appropriate to bill 75820? During a diagnostic procedure not being interventional?



It would be appropriate when there is documentation of medical necessity of diagnosing a venous extremity symptom/problem such as venous insufficiency, thrombus or embolus: and a study (injection/interpretation) dedicated to the venous extremities is performed.

It is rarely (almost never, IMO) appropriate in the setting of placement of heart assist devices or Electrophysiology procedures.

HTH


----------



## Jim Pawloski (Dec 16, 2009)

dpeoples said:


> It would be appropriate when there is documentation of medical necessity of diagnosing a venous extremity symptom/problem such as venous insufficiency, thrombus or embolus: and a study (injection/interpretation) dedicated to the venous extremities is performed.
> 
> It is rarely (almost never, IMO) appropriate in the setting of placement of heart assist devices or Electrophysiology procedures.
> 
> HTH



Hi Danny,
So if the doctor says the an subclavian venogram was performed, and the vein is patient, before insertion of either a pacemaker or ACID.  This should not be billed?


----------



## dpeoples (Dec 16, 2009)

Jim Pawloski said:


> Hi Danny,
> So if the doctor says the an subclavian venogram was performed, and the vein is patient, before insertion of either a pacemaker or ACID.  This should not be billed?



That is correct. Venography to evaluate for passage of heart assist device is considered part of the procedure.

HTH


----------

