We have several opportunities to celebrate in February including Valentine’s Day, President’s Day, Black History, Heart Health, and the list goes on. As Revenue Cycle professionals, medical coding professionals, and medical billing experts, we can also celebrate the positive energy generated with learning. Recently, I was reminded of one of my favorite quotes, “Sometimes we are tested not for our weaknesses but to discover our strengths”.
Passing along nuggets that can help us evaluate the documentation in our records, potentially add to our reimbursement and certainly ensure we are all reporting accurate, quality data is the catalyst behind the ECLAT blog. Today’s pearl involves temporary pacemaker insertion.
TEMPORARY PACEMAKER INSERTION
This 70-year-old male with atrial fibrillation has been placed on a combination of digoxin, metoprolol, and Cardizem. Presenting to the Emergency Department, he was profoundly weak, near syncope. ECG showed atrial fibrillation with slow ventricular response in the 20s and 30s. Digoxin level was 2.9. Digibind was given in the Emergency Department. A slow ventricular rate in the 30s continued, and a decision was made to insert a temporary pacer wire.
The procedure was performed in the cardiac catheterization laboratory. Groins were prepped and draped in the usual sterile fashion. After infiltration with lidocaine, the right femoral vein was entered via percutaneous technique without difficulty and a 6 French sheath was advanced over the guidewire. Balloon-tipped temporary pacer wire was advanced under fluoroscopy into the right ventricular apex. Threshold was less than 1mA. The patient tolerated the procedure well with no immediate complications. Temporary wire was set at 60 beats per minute with a current of 3mA. The patient was transferred out of the catheterization lab in stable condition. Cardizem and metoprolol were held.
When coding insertion of a temporary pacemaker (ventricular) in PCS (5A1213Z or 5A1223Z) there is no prompt to code also the lead. However, according to the Coding Handbook Chapter 27- Cardiac Pacemaker Therapy, there is a directive to, “plus the appropriate code for the lead insertion”.
A question was sent to AHA Coding Clinic yielding the following response,
“…In a temporary pacemaker insertion, leads are inserted via a catheter and attached to an external generator. This type of pacemaker is generally used for an acutely ill patient until a permanent pacemaker can be inserted. Temporary pacemaker procedures are classified to 5A1213Z or 5A1223Z …plus the appropriate code for the lead insertion.”
In our example above, this patient did not have a permanent pacemaker inserted, and was medically managed. Adding the lead changed the DRG from a medical DRG to a surgical DRG with an increase in reimbursement.
Challenge: You may want to look at your data, pulling accounts with temporary pacers in medical DRGs to ensure the lead was assigned.