You Be the Coder:
Unsuccessful Pacemaker Insertion
Published on Wed Jan 01, 2003
Test your coding knowledge. Determine how you would code this situation before looking at the box below for the answer.
Question:
Our cardiologist punctured the left subclavian vein but did not engage the coronary sinus after multiple attempts. He then punctured the femoral vein and used a catheter from the right femoral vein to engage the coronary sinus in retrograde fashion. He viewed the coronary sinus by cineangiography and found a curved ostium. The physician made multiple attempts from the left subclavian vein that were unsuccessful in engaging the coronary sinus. He aborted the procedure due to the maximum limit in fluoroscopy. My impression is that the codes for a successful biventricular pacemaker insertion are:
33208 Insertion or replacement of permanent pacemaker with transvenous electrodes(s); atrial and ventricular
33999 Unlisted procedure, cardiac surgery (for the left ventricular lead)
71090-26 Insertion pacemaker, fluoroscopy and radiography, radiological supervision and interpretation; professional component
75860-26 Venography, sinus or jugular, catheter, radiological supervision and interpretation.
The codes I have used are 36000, 75860-26. I considered using 71090-26,-53 (
Discontinued procedure). Does this combination sound appropriate?
Wisconsin Subscriber
Answer: You could encounter problems if you report 36000* (Introduction of needle or intracatheter, vein) and 75860 (Venography, sinus or jugular, catheter, radiological supervision and interpretation). The Correct Coding Initiative (CCI) bundles 36000 into 75860. Reporting these codes together to Medicare or any payers with similar bundling edits should generate an automatic denial.
Also, the AMA has specified that the correct way to report coronary sinus venography is with the unlisted-procedure code 76499 ( Unlisted diagnostic radiographic procedure). Code 75860 (Venography, sinus or jugular) actually refers to venography in the sinus veins of the skull that carry oxygen-poor blood from the skull to the jugular veins, so this code would be inappropriate for the procedure you describe.
When a physician performs venography with biventricular lead placement, however, the AMA specifies that this visualization procedure (and the associated catheter placement) is part of the service reported with the unlisted cardiac surgery code (33999), assuming that the procedure occurred prior to the effective date of the 2003 code additions.
Because the physician attempted left ventricular lead placement, you should report the service with the unlisted-procedure code mentioned above. In your cover letter to the payer, make sure to stress the difficulties encountered, as illustrated by the multiple approaches you describe. Also stress that the cardiologist discontinued the procedure due to unacceptable risk to the patient if the physician had made additional attempts to place the lead.
Attach a copy of the operative report to the claim to document the amount of work and effort that went into the service. Compensation would be based on the documentation. | |
