Ask Dr. Z

Per the Q&A below code 33210, should not be billed when done with an intervention. Is that because the TVP was removed at the end of the intervention? Has this guideline changed since 2010? The doctor states that it takes additonal work and time to insert the pacemaker and he should be getting reimbursed for it. If we cannot bill 33210, when done with an intervention, should we append modifier 22 to 92980/92982 etc? Also, what if only a diagnostic heart cath/coronary angiogram is being done and the pt has episode of bradycardia. Can 33210 be billed? Date: Friday, April 30, 2010 Question: Please advise when to report temporary pacemaker with modifier -59. The Q & A's that I reviewed (#325 & 1554) do not match my billing scenario. Patient is admitted for complex percutaneous coronary intervention on three vessels (third redo). LVAD is inserted into the left ventricle which caused a complete heart block. Temporary pacemaker was then inserted. At the completion of the complex procedure, the LVAD was removed along with the pacemaker. Can 33210 be reported with modifier -59? Thank you Answer: Again, we would not recommend using 33210 as it is considered part of any coronary artery intervention. The use of a Percutaneous non-transseptal LVAD, such as Impella, is 33999. Dr.z Thank you for all of your help.