Cardiology Coding Alert

Question: While performing a thrombectomy using the Angio-Jet catheter, the cardiologist places a temporary pacing wire. Sometimes this is done prophylactically, but during a thrombectomy, patients may develop bradycardia and the wire is required to pace the heart. I understand that 33210 (Insertion or replacement of temporary transvenous single chamber cardiac electrode or pacemaker catheter) is bundled with heart caths and stents. But in this case, can I bill 33210 separately because of the thrombectomy? Ohio Subscriber Answer: The fact that a percutaneous thrombectomy was performed does not affect the guidelines for billing 33210 separately during a cath or intervention. Although 33210 is bundled with stent placement (92980) and left heart caths (93510), the edit in the national Correct Coding Initiative (CCI) has a "1" indicator, which means it may be bypassed in certain circumstances by appending modifier -59 (Distinct procedural service).

When the temporary pacing wire is placed for preventive, or prophylactic, reasons, it is included in the stent or PTCA and 33210 should not be reported. If, however, the pacing wire is inserted because the patient has bradycardia, for example, it may be reported with modifier -59 appended. Make sure the cardiologist documents the medical necessity for the pacing wire to support the use of modifier -59.