Ask Dr. Z

I have a hospital that charged for temporary pacing prior to cardiac intervention. Here is the documentation:

After written informed consent was obtained, right groin was anesthetized with 2% xylocaine. Using modified Seldinger technique, a 7 French sheath was inserted in the right femoral artery. A 7 French CLS-4 guiding catheter was used to cannulate the left coronary artery. Angiomax was given per protocol. A 6 French sheath was inserted in the right femoral vein, and a transvenous pacemaker was placed at the RV apex to prevent bradyarrhythmias. After which, a choice PT extra support wire was advanced distally to the OM. Over wire exchange was done for a Roto extra support wire. Rotational atherectomy was performed with a 1.5-mm burr. Thereafter, a 2.5x10 cutting balloon was placed and inflations were done with a cutting balloon. Thereafter, IVUS was performed. IVUS revealed heavily calcified vessel, diffusely diseased approximately 2.75 vessel distally and a 3.5 vessel proximally. A 2.75 x 30 Resolute drug-eluting stent was deployed. A second Resolute 3.5 x 12 was deployed proximally. Post-stent deployment, IVUS revealed good stent wall apposition. There is TIMI-1 flow into the second OM. The wire was then repositioned into the OM, and a 2.25 x 12 Sprinter balloon was inflated across the second OM. There was TIMI-3 flow, less than 10% residual stenosis. Wire was removed. Final images obtained. Femoral angiogram revealed access to be in the common femoral artery above the bifurcation. There was no severe atherosclerotic disease. Angio-seal closure device was deployed with good hemostasis. Patient tolerated the procedure well and left the cardiovascular lab in stable condition. The left main had mild disease, and bifurcates into the left anterior descending and circumflex arteries. The left anterior descending artery has widely patent stents in the mid segment. The circumflex artery has a heavily calcified 90-95% proximal stenosis followed by a 95% stenosis in OM1. Femoral angiogram revealed access to be in the common femoral artery, and Angio-Seal closure device deployed with good hemostasis. Patient tolerated the procedure well and left the cardiovascular lab in stable condition. (I think this last sentences is a repeat of what he said above?)

Department reported codes 92953, 92978, C9602, and 33210.  I'm not sure that code 33210 should be charged. Wouldn't it be considered part of the procedure? Please advise.