Temporary Pacemakers

A temporary pacemaker is inserted for reasons such as:

1. As an emergency procedure when medication is ineffective
2. While awaiting a permanent pacemaker
3. As a temporary measure to determine whether the patient's heart will return to normal state

Medical indications for the insertion of a temporary pacemaker include the following:

• Symptomatic bradycardia (427.81-427.89) or heart block (426-426.6, 426.9)
• Acute anterior wall MI (410.0-410.12) with a right bundle branch block (426.4) and left anterior hemiblock (426.2)
• Overdrive pacing for resistant ventricular tachycardia

Payment may be made to the same doctor or to different doctors for consultation or medical treatment for the heart condition and the insertion of a temporary pacemaker.

When a temporary pacemaker is inserted during diagnostic or therapeutic cardiac procedures, payment may be made for the temporary pacemaker only when it is the highest paying procedure.

However, when a temporary pacemaker is inserted in conjunction with left cardiac catheterization, the claim should be processed under code 93799.

Claims reporting the insertion of a temporary pacemaker performed in conjunction with a right heart catheterization should be given individual consideration. It will be necessary for the provider to submit medical records and/or additional documentation to determine coverage in this situation.

Permanent Pacemaker

Indications for the insertion of a permanent pacemaker include the following:

• The patient has complete atrioventricular block lasting more than 3 weeks following an acute myocardial infarction or persistent A-V block following cardiac surgery.
• Advanced second degree block
• Symptomatic sinus bradycardia without A-V block
• Symptomatic bilateral bundle branch block/trifascicular block
• Symptomatic sinus arrest, sick sinus syndrome, sinoatrial block
• Symptomatic incomplete A-V block (mobitz type I)(426.13)

When a surgeon submits a claim for insertion of a permanent pacemaker, and medical care, only the insertion of the pacemaker should be paid. If unusual circumstances or complications arise, the claim should be processed in accordance with the guidelines set forth in Medical Policy Bulletin V-28 (Inpatient Preoperative Care).

When one doctor inserts the permanent pacemaker and another doctor provides the medical care, follow the guidelines issued in Medical Policy Bulletin V-2 (Concurrent Care).

Insertion of an Atrio-Ventricular Sequential Pacemaker or a Universal Pacemaker involves the additional placement of an electrode in the atrium as well as the ventricle. Claims requesting payment for either of these services should be processed under code 33208.

If the surgeon reports the insertion of a permanent pacemaker (epicardial, transvenous, A-V sequential or universal) and electrodes in conjunction with open heart surgery, payment should be made in accordance with the guidelines for multiple surgical procedures in Medical Policy Bulletin S-100.

Pacemaker analysis can involve evaluation of programmed parameters, lead(s), battery, capture and sensing function, and heart rhythm. Often, but not always, the sensor rate response, lower and upper heart rates, AV intervals, pacing voltage and pulse duration, sensing value, and diagnostics will be adjusted during a programming evaluation.

Codes 93279-93281 represent a programming device evaluation with physician review and analysis. This is an "in person" service.

Code 93286 represents a periprocedural analysis with physician review and analysis. This is an "in person" service. This is an adjustment of the pacemaker prior to a surgery, procedure, or test, and is normally performed before and after the procedure. It can be done by the same provider, in which case the code would be reported twice, or by different providers, each would report the procedure code once.

Code 93288 represents an "in person" device interrogation with physician review and analysis. This code is used when reprogramming is not required.

Codes 93294 and 93296 represent "remote" interrogation device evaluation which involves the retrieval of stored and measured information to determine the current programming and settings. These codes can be reported only once in 90 days. Charges billed more frequently within the 90-day period are considered part of the global allowance and are not eligible for separate payment. A participating, preferred, or network provider cannot bill the member for the denied service(s).

NOTE:

Also see Medical Policy Bulletin S-44 (Implantation of a Permanent Pacemaker by One or Two Physicians).

Transcutaneous Pacer Application

Transcutaneous pacemaker application is considered an integral part of a doctor's medical care. It is not eligible as a distinct and separate service when performed with medical care. If the transcutaneous pacemaker application is reported on the same day as medical care, and the charges are itemized, combine the charges and pay only the medical care. Payment for the medical care performed on the same date of service includes the allowance for the transcutaneous pacemaker application. A participating, preferred, or network provider cannot bill the member separately for the transcutaneous pacemaker application in this case.

If the transcutaneous pacemaker application is performed independently, process it under code 92953.

Modifier 25 may be reported with medical care to identify it as a significant, separately identifiable service from the transcutaneous pacemaker application. When the 25 modifier is reported, the patient’s records must clearly document that separately identifiable medical care has been rendered.

Description

The artificial cardiac pacemaker is a device designed to electronically stimulate the heart in a specific sequence that enables it to contract. This device is used primarily when the heart's own intrinsic pacemaker, the sinoatrial node, fails due to various disease conditions. There are three different types of pacemakers categorized by how they are applied: temporary pacemakers, transcutaneous pacer application, and permanent pacemakers.

Permanent Pacemaker

When a normal heart function cannot be restored, a permanent pacemaker is inserted for the persistent conduction defect.

Transcutaneous Pacer Application

Transcutaneous pacing is a non-invasive procedure that involves the application of electrodes to the chest wall of the patient. Electrical current is then delivered via the electrodes to achieve pacing. This procedure may be performed as an emergency alternative to temporary pacemaker insertion.

This medical policy may not apply to FEP. Medical policy is not an authorization, certification, explanation of benefits, or a contract. Benefits are determined by the Federal Employee Program.