Cardiology Coding Alert

Question: Should we bill a temp pacer implant with a generator replacement during the same session or would that usually be considered a bundled component? If a patient developed a complication later in the day (such as a hematoma in the pacemaker pocket), should I bill that separately with a modifier for the return trip to the operating room?


Massachusetts Subscriber

Answer: The temporary pacemaker codes (such as 33210, Insertion or replacement of temporary transvenous single chamber cardiac electrode or pacemaker catheter [separate procedure]) are components of the generator implantation (such as 33208, Insertion or replacement of permanent pacemaker with transvenous electrode[s]; atrial and ventricular).

The scenario you present would be an example of when you should use a modifier to bypass the National Correct Coding Initiative edits.

In this case, modifier 78 (Return to the operating room for a related procedure during the postoperative period) is the most accurate. You should apply this modifier to the temporary pacemaker code (33210).