Use Modifier -59 to Get Paid For Temporary Pacer Insertion
Published on Sun Oct 01, 2000
Medicares national Correct Coding Initiative (CCI) bundles the insertion of a temporary pacemaker (33210, insertion or replacement of temporary transvenous single chamber cardiac electrode or pacemaker catheter [separate procedure]) to procedures such as percutaneous transluminal coronary angioplasties (PTCAs) (92982), stents (92980) or atherectomies (92995) when the insertion is performed during coronary interventions. In some circumstances, however, it may be appropriate to bill separately for the temporary pacemaker insertion.
In such cases, modifier -59 (distinct procedural service) should be attached to 33210, and, in the event of an audit, documentation must indicate why 33210 was separately billed, says Susan Callaway-Stradley, CPC, CCS-P, an independent coding consultant and educator based in North Augusta, S.C.
Temporary Pacemaker Use
The CCI edit that bundles 33210 to coronary interventions has existed for several years, explains Martha Gerant, CPC, a coder with Cardiology Services, an 11-physician practice in Shawnee Mission, Kan. When interventions were relatively new procedures, cardiologists anticipated there might be cardiac arrhythmia problems during the intervention, so the temporary pacer was installed, regardless of whether it was used, she says.
In the old days, temporary pacers were routinely installed before interventions because the interventions were new and risky and cardiologists werent as proficient as they are now in performing them. The cardiologist would do a femoral puncture stick first, install the lead wires (with the temporary generator placed outside the body) and then perform the intervention, Gerant says.
When using this technique, the patient may develop complications during the process of the intervention, such as cardiac arrest (427.5), severe bradycardia (427.89), second degree block (426.13) or Mobitz II atrioventricular block (426.12). When this occurred, the temporary pacemaker would help support the hearts function.
Gerant points out that installing temporary pacemakers for such backup purposes is no longer standard procedure for cardiologists. Sometimes, however, a patient may develop a serious problem during or after an intervention, such as complete heart block (426.0). In such cases, a temporary pacer will be inserted to treat the life-threatening arrhythmia.
How to Get Temporary Pacemaker Payment
Although the CCI edit is still in effect, the insertion of the temporary pacer in this situation is payable, but only if modifier -59 is appended to the 33210 and documentation that justifies the need for temporary pacing separate from the intervention is sent along with the claim, according to the American College of Cardiology (ACC).
Medicodes Coding Illustrated Cardiovascular and Respiratory concurs, stating: When performed alone or with other unrelated procedures/services, [33210] may be reported. If performed alone, list the code; if performed with other [...]
