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Radiology Coding Alert

Reader Question:

Append -52 for Pacemaker, No Pocket

Question: How should we bill for a pacemaker procedure when the physician inserted the pacemaker and leads, but a different doctor created the surgical pocket?

Arizona Subscriber
Answer: You should report 33208 (Insertion or replacement of permanent pacemaker with transvenous electrode[s]; atrial and ventricular) for the procedure and append modifier -52 (Reduced services).
Skin pocket development is part of the pacemaker implant, and if another physician performs that portion of the procedure, your insurer will reduce your reimbursement accordingly.
You should also report 71090-26 (Insertion pacemaker, fluoroscopy and radiography, radiological supervision and interpretation; Professional component) for the fluoroscopy the physician used during the pacemaker insertion.

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