Cardiology Coding Alert

Question: Would you clarify the difference between fluoroscopy codes 76000 and 71090? We have always used 76000 when the physician inserts a temporary pacemaker, and 71090 when he inserts a permanent pacemaker. Is this correct? Massachusetts Subscriber

Answer: There are several reasons why you should not use 76000 (Fluoroscopy [separate procedure], up to one hour physician time, other than 71023 or 71034] [e.g., cardiac fluoroscopy]) for the fluoroscopic guidance during temporary pacemaker lead insertion.

First, the National Correct Coding Initiative (NCCI) bundles 76000 into the temporary pacemaker insertion codes (33210-33211). NCCI allows you to circumvent this edit if you append modifier -59 (Distinct procedural service), but fluoroscopy during lead insertion does not constitute a separate procedure. Consequently, modifier -59 would not apply to this service. The second reason is that 76000's descriptor specifically includes the term "separate procedure." Because the cardiologist in this example used fluoroscopy during the implant, it would not constitute a separate procedure.

Instead, you should report 71090-26 (Insertion pacemaker, fluoroscopy and radiography, radiological supervision and interpretation; professional component) to represent the fluoroscopic guidance during your temporary lead insertion. "This is specific to pacemakers and has everything built in," says Brian Outland, CPC, CCS, coding and reimbursement specialist with NASPE - Heart Rhythm Society. The code definition for 71090 does not specify that the pacemaker must be permanent rather than temporary.