Cardiology Coding Alert

Question: Our cardiologist placed a stent and inserted a temporary pacemaker. Can we bill for insertion of the temporary pacer? Arizona Subscriber Answer: It depends on why the temporary pacemaker was inserted.

If the temporary pacer was placed prophylactically (i.e., to prevent a potential problem), it is included in the stent placement (92980).

If the patient has an arrhythmic diagnosis, the pacemaker is medically necessary and may be billed separately. CPT includes two codes for temporary pacer insertions: 33210 (Insertion or replacement of temporary transvenous single chamber cardiac electrode or pacemaker catheter [separate procedure]) and 33211 (Insertion or replacement of temporary transvenous dual chamber pacing electrodes [separate procedure]). As separate procedures, neither code is normally billed with another procedure. If the patient requires the temporary pacer due to an arrhythmia, modifier -59 (Distinct procedural service) should be appended to either 33210 or 33211 to indicate that the service was medically necessary and, therefore, not included in the stent. Correct Coding Initiative version 8.2 (effective July 1, 2002) bundles 33210 with 92980, but does not include 33211. Nonetheless, both codes are separate procedures, which means that under normal circumstances (i.e., when the pacers are inserted prophylactically), they should not be billed with the stent.