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Pacemaker coding

  1. #1
    Default Pacemaker coding
    Medical Coding Books
    How would anyone code this?
    Procedure:

    Selective venography of left upper extremity.
    Implantation of right atrial and right ventricular leads under fluoroscopy,
    Implantation of dual chamber pacemaker.

  2. #2
    Location
    Phoenix, AZ
    Posts
    620
    Default
    Is that the entire documentation for the procedure? That's not enough to code.
    Cyndi Allen, CPC, CIRCC
    2015 Local Chapter President, Casa Grande, AZ

  3. #3
    Default Here is the entire note.
    After inj of 2% lidocaine in the pectoral area, an incision was made and extended to pectoralis fascia using blunt dissection and a pocket was created. Due to difficult venous access, sel venograohy of the L upper extremity was done. Access to the axillary vein was achieved and under fluoroscopy, the R atrial lead was advanced to R atrial appendage and R ventricular lead to the R ventricular septum. These were secured to the fascia, connected to the device and inserted into pocket and the device was sutured to the pocket.

  4. Default
    Hello,

    The correct codes to bill are 33208 (dual chamber/lead pacemaker) & 71090-26 ( fluoroscopy guidance) You cannot bill for the accessing the L upper extremity vessel or axillary vein, this is included in the placement of the leads/pacemaker.

    Hope this helps

    Dolores, CPC-CCC
    Last edited by deeva456; 12-07-2009 at 01:40 PM.

  5. #5
    Default
    Thanks a lot. This was billed 33208, 36005-59, 75820-26,59 and I wasn't sure that was correct. When would it be appropriate to bill 75820? During a diagnostic procedure not being interventional?

  6. Default
    33208 for dual chamber p/m (includes access/closure)
    71090-26 fluoroscopy if documented

  7. #7
    Location
    Birmingham, Alabama
    Posts
    889
    Default
    Quote Originally Posted by ktden View Post
    Thanks a lot. This was billed 33208, 36005-59, 75820-26,59 and I wasn't sure that was correct. When would it be appropriate to bill 75820? During a diagnostic procedure not being interventional?
    It would be appropriate when there is documentation of medical necessity of diagnosing a venous extremity symptom/problem such as venous insufficiency, thrombus or embolus: and a study (injection/interpretation) dedicated to the venous extremities is performed.

    It is rarely (almost never, IMO) appropriate in the setting of placement of heart assist devices or Electrophysiology procedures.

    HTH
    Danny L. Peoples
    CIRCC,CPC

  8. #8
    Default
    Quote Originally Posted by dpeoples View Post
    It would be appropriate when there is documentation of medical necessity of diagnosing a venous extremity symptom/problem such as venous insufficiency, thrombus or embolus: and a study (injection/interpretation) dedicated to the venous extremities is performed.

    It is rarely (almost never, IMO) appropriate in the setting of placement of heart assist devices or Electrophysiology procedures.

    HTH
    Hi Danny,
    So if the doctor says the an subclavian venogram was performed, and the vein is patient, before insertion of either a pacemaker or ACID. This should not be billed?

  9. #9
    Location
    Birmingham, Alabama
    Posts
    889
    Default
    Quote Originally Posted by Jim Pawloski View Post
    Hi Danny,
    So if the doctor says the an subclavian venogram was performed, and the vein is patient, before insertion of either a pacemaker or ACID. This should not be billed?
    That is correct. Venography to evaluate for passage of heart assist device is considered part of the procedure.

    HTH
    Danny L. Peoples
    CIRCC,CPC

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