Cardiology Coding Alert

Question:Which codes should I report when the cardiologist inserts a dual-chamber pacemaker using the subclavian vein? The diagnoses are tachy-brady and sick sinus syndrome.Michigan SubscriberAnswer:For the pacemaker insertion, you should report 33208 (Insertion or replacement of permanent pacemaker with transvenous electrode[s]; atrial and ventricular). Code 33208 is specific to dual-chamber systems, which include one electrode (lead) in the right atrium and another electrode in the right ventricle.If the cardiologist also documents electrode(s) were implanted under fluoroscopy guidance be sure to report 71090 (Insertion pacemaker, fluoroscopy and radiography, radiological supervision and interpretation). If the procedure took place in a facility, append modifier 26 (Professional component) to 71090 to indicate you're reporting only the physician's services.For the diagnosis, 427.81 (Sinoatrial node dysfunction) covers both sick sinus syndrome and tachycardia-bradycardia. Sick sinus syndrome is the name used for a group of arrhythmias, or abnormal heartbeats. It can result in tachycardia (fast heart rate), [...]