Cardiology Coding Alert

Question: Our cardiologist would like to bill 36010 with her dual pacemaker insertion. She maintains that when she punctures the right cephalic vein and advances the wire into the inferior vena cava for lead placement, the procedure justifies billing this code. She also claims that we should bill 36010 with 33208. Is she correct? Georgia Subscriber Answer: Your physician seems to be incorrect. When the physician introduces and places catheters and guidewires as part of a permanent pacemaker placement, these services are included in the permanent pacemaker insertion code (33208, Insertion or replacement of permanent pacemaker with transvenous electrode[s]; atrial and ventricular), according to CPT guidelines. During pacemaker insertion, physicians access the central caval veins through the subclavian vein or jugular vein. They then penetrate the vein with a large needle and pass a wire through. This access is included in the CPT code for the pacemaker insertion, so you would not report 36010 (Introduction of catheter, superior or inferior vena cava) separately.