Cardiology Coding Alert

Question: I know that 93650's descriptor says it covers ablation "with or without temporary pacemaker placement." Does that mean temporary pacemaker placement is included in the service, or may I code it separately?

Kansas Subscriber

Answer: You should not report temporary pacemaker placement performed at the same time as the ablation, 93650 (Intracardiac catheter ablation of atrioventricular node function, atrioventricular conduction for creation of complete heart block, with or without temporary pacemaker placement).

Rationale: CPT designates both 33210 (Insertion or replacement of temporary transvenous single chamber cardiac electrode or pacemaker catheter [separate procedure]) and 33211 (Insertion or replacement of temporary transvenous dual chamber pacing electrodes [separate procedure]) as "separate procedures."

CPT's "Surgery Guidelines" indicate that you should not report "separate procedure" codes in addition to the service code it's an integral component of. Cardiologists may place the temporary pacemaker at the same session as ablation because an AV node ablation creates a complete block of electrical stimuli moving from the atrium to the ventricles.

Correct Coding Initiative edits cement the deal by bundling 33210 and 33211 into 93650 (Intracardiac catheter ablation of atrioventricular node function, atrioventricular conduction for creation of complete heart block, with or without temporary pacemaker placement). The edit has a modifier indicator of "1,"

meaning you may override the edit -- but only if you have excellent support, such as the two services taking place at separate sessions.

Note that if the cardiologist placed a permanent pacemaker during the ablation session, you could report that insertion separately.