Cardiology Coding Alert

Question: The cardiologist inserted a temporary transcutaneous pacer in a patient one day before placing a permanent pacemaker. How should I code this?

Kentucky Subscriber

Answer: For the temporary transcutaneous pacemaker insertion, you should report 33210 (Insertion or replacement of temporary transvenous single chamber cardiac electrode or pacemaker catheter [separate procedure]) or 33211 (Insertion or replacement of temporary transvenous dual chamber pacing electrodes [separate procedure]), depending on which type of temporary pacer the cardiologist installed. This insertion is not bundled into the subsequent permanent pacemaker placement.

Also, the cardiac physician will likely use fluoroscopic guidance to place the temporary pacemaker. For this, you should bill 71090 (Insertion pacemaker, fluoroscopy and radiography, radiological supervision and interpretation). If the cardiologist performs this procedure in a hospital or other facility, which is likely, you should append 71090 with modifier -26 (Professional component).