Ask Dr. Z

Physician planned an RFA of dual AV node physiology for SVT. Comprehensive EPS was performed, with recording of the high atrium, His bundle region, RV apex, and coronary sinus. Standard pacing protocols done. After the RF lesions were placed, the patient developed complete heart block. They waited 30 minutes and AV nodal conduction did not return, so "the atrial and ventricular pacing catheters and their sheaths were secured into place with a silk suture." The statement in the quotes is what is confusing to us. Were those the EPS pacing catheters being used as pacemaker leads? Nowhere in the description does it state that a temporary pacemaker had been placed. Or were the pacing leads he is referring to just be a temporary dual transvenous pacer and he just failed to tell us that he placed earlier? The physician does state that a "temporary dual chamber pacemaker placement" in his procedure list. The discussion does state that "there is a back-up dual chamber transvenous pacing system in place should the patient become unstable." Should we report 33211-59?