pacemaker coding

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I am a physician coder for Vascular Surgery & Med Cardio. When coding pacemaker encounters for example my physicians would report:

33207 Insertion or replacement of pacemaker; ventricular

33206 Insertion or replacement of pacemaker; atrial

33213 Insertion or replacement of pacemaker pulse generator only

33210 Insertion or replacement of temporary pacemaker catheter

71090 x2 Insertion pacemakers S&I

My question I suppose is how can they use permanent pacemaker codes, which guidelines specify (on page 144 and the top right hand side)that codes 33206-33208 include subcutaneous insertion of pulse generator & transvenous placement of electrodes, and also report temporary codes 33213 & 33210 on the same encounter. Would this be over coding? When I put the codes in Custom Coder (scrubber) it only flagged that I use modifiers on code 33207, 33213, & 33210. I will be waiting for your view.
 

Davistm

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A little humor. Was the patient an alien with two hearts?

Something appears very wrong with the coding and with the scrubber results. To really help, I need more information. What exactly did the physician do? Did the patient have an existing device that was replaced or was this the initial placement of a device?

In general, if this was the initial implantation of a PM, then you report one code: 33206 for single lead/atrial; or 33207 for single lead/ventricle; or 33208 for dual leads/atrial and ventricle. You also report 71090-26 for radiological guidance during lead placement.

If you give me more details on the procedure, I can give you a more specific answer and the logic.

Terry Davis
CPC
 
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