Cardiology Coding Alert

Question: Our cardiologist performed a left-heart catheterization (LHC) on a patient. During the procedure, he inserted a temporary pacemaker. The report reads as follows: "Along with reperfusion, the patient developed marked bradyarrhythmias. He was given 1 milligram of atropine, and a temporary pacemaker was placed. Ability to capture was verified, but the pacemaker did not have to be used afterward." Should we bill for the pacemaker?

Rhode Island Subscriber Answer: You can bill for the temporary pacemaker because the patient was having a problem (for example, bradyarrhythmias, 427.89). To indicate that the insertion of the temporary pacemaker was distinct from other services performed the same day, append modifier -59 (Distinct procedural service) to the appropriate temporary pacemaker code (33210, Insertion or replacement of temporary transvenous single chamber cardiac electrode or pacemaker catheter [separate procedure]; or 33211, Insertion or replacement of temporary tranvenous dual chamber pacing electrodes [separate procedure]). Report 71090 (Insertion pacemaker, fluoroscopy and radiography, radiological supervision and interpretation) for the imaging.

If the physician inserts the pacemaker as a preventive measure rather than to treat a particular problem, the procedure is bundled with the catheterization, and codes 33210 and 33211 should not be reported separately.