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Official Description

Insertion or replacement of temporary transvenous single chamber cardiac electrode or pacemaker catheter (separate procedure)

© Copyright 2025 American Medical Association. All rights reserved.

Common Language Description

The procedure described by CPT® Code 33210 involves the insertion or replacement of a temporary transvenous single chamber cardiac electrode or pacemaker catheter. This procedure is classified as a separate procedure, indicating that it is distinct from other surgical interventions. A temporary cardiac pacemaker is a device that delivers electrical impulses to the heart, helping to regulate its rhythm, particularly in cases of arrhythmias that are expected to be temporary. These arrhythmias may arise due to various factors, including medication effects, electrolyte imbalances, or acute cardiac conditions. Temporary pacemakers can be either single chamber, which means they stimulate one of the heart's chambers (either the atrium or ventricle), or dual chamber, which stimulates both chambers. The transvenous approach specifically refers to the placement of the pacemaker leads within the heart chambers, known as endocardial placement, as opposed to epicardial placement where leads are placed on the surface of the heart. The procedure typically involves making an incision in the upper chest to access a vein, through which a sheath is inserted to facilitate the advancement of the pacemaker wire into the heart. This method allows for precise placement of the leads, ensuring they are positioned against the heart wall for optimal function. After placement, the leads are tested for proper functionality before being connected to a pulse generator, which is then secured to the patient's skin or worn on a belt. This procedure is critical for patients who require temporary pacing support until their heart rhythm stabilizes or until a permanent pacemaker can be implanted.

© Copyright 2025 Coding Ahead. All rights reserved.

1. Indications

The insertion or replacement of a temporary transvenous single chamber cardiac electrode or pacemaker catheter is indicated for the following conditions:

  • Temporary Arrhythmias - These are irregular heart rhythms that are expected to resolve, necessitating temporary pacing support.
  • Pre-emptive Support - Used until a permanent pacemaker can be placed in patients with ongoing cardiac rhythm issues.

2. Procedure

The procedure for the insertion or replacement of a temporary transvenous single chamber cardiac electrode or pacemaker catheter involves several critical steps:

  • Step 1: Preparation - The patient is positioned appropriately, and the upper chest area is cleaned and sterilized to minimize the risk of infection. Local anesthesia may be administered to ensure patient comfort during the procedure.
  • Step 2: Accessing the Vein - An incision is made in the skin of the upper chest to expose the cephalic, subclavian, or jugular vein. This access point is crucial for the subsequent placement of the pacemaker leads.
  • Step 3: Insertion of Sheath - A sheath is inserted into the selected vein, providing a pathway for the pacemaker wire to be advanced into the heart. This step is performed under radiological guidance to ensure accurate placement.
  • Step 4: Placement of Pacemaker Wire - The pacemaker wire is carefully advanced through the sheath into the appropriate heart chamber, either the right atrium or right ventricle, depending on the type of pacemaker being used.
  • Step 5: Positioning the Lead - Once the wire is in place, it is positioned against the wall of the heart chamber to ensure effective pacing. If a dual chamber device is required, a second wire is threaded to the other chamber and positioned similarly.
  • Step 6: Testing the Leads - The leads are tested to verify their functionality, ensuring they are correctly stimulating the heart as intended.
  • Step 7: Connecting to Pulse Generator - After confirming that the leads are functioning properly, they are connected to the pulse generator, which is then tested to ensure it is delivering the appropriate electrical impulses.
  • Step 8: Securing the Device - Once the pulse generator is confirmed to be operational, it is secured to the patient's skin with tape or attached to a belt worn by the patient, allowing for mobility while maintaining pacing support.

3. Post-Procedure

After the procedure, the patient is monitored for any complications or adverse reactions. It is essential to ensure that the temporary pacemaker is functioning correctly and that the patient is stable. The healthcare team will provide instructions regarding activity restrictions and care of the insertion site to prevent infection. Follow-up appointments may be scheduled to assess the patient's heart rhythm and determine the need for a permanent pacemaker if the arrhythmia persists.

Short Descr INSERT ELECTRD/PM CATH SNGL
Medium Descr INSJ/RPLCMT TEMP TRANSVNS 1CHMBR ELTRD/PM CATH
Long Descr Insertion or replacement of temporary transvenous single chamber cardiac electrode or pacemaker catheter (separate procedure)
Status Code Active Code
Global Days 000 - Endoscopic or Minor Procedure
PC/TC Indicator (26, TC) 0 - Physician Service Code
Multiple Procedures (51) 2 - Standard payment adjustment rules for multiple procedures apply.
Bilateral Surgery (50) 0 - 150% payment adjustment for bilateral procedures does NOT apply.
Physician Supervisions 09 - Concept does not apply.
Assistant Surgeon (80, 82) 1 - Statutory payment restriction for assistants at surgery applies to this procedure...
Co-Surgeons (62) 0 - Co-surgeons not permitted for this procedure.
Team Surgery (66) 0 - Team surgeons not permitted for this procedure.
Diagnostic Imaging Family 99 - Concept Does Not Apply
APC Status Indicator Hospital Part B services paid through a comprehensive APC
ASC Payment Indicator Non office-based surgical procedure added in CY 2008 or later; payment based on OPPS relative payment weight.
Type of Service (TOS) 2 - Surgery
Berenson-Eggers TOS (BETOS) P2E - Major procedure, cardiovascular-Pacemaker insertion
MUE 1
CCS Clinical Classification 48 - Insertion, revision, replacement, removal of cardiac pacemaker or cardioverter/defibrillator
59 Distinct procedural service: under certain circumstances, it may be necessary to indicate that a procedure or service was distinct or independent from other non-e/m services performed on the same day. modifier 59 is used to identify procedures/services, other than e/m services, that are not normally reported together, but are appropriate under the circumstances. documentation must support a different session, different procedure or surgery, different site or organ system, separate incision/excision, separate lesion, or separate injury (or area of injury in extensive injuries) not ordinarily encountered or performed on the same day by the same individual. however, when another already established modifier is appropriate it should be used rather than modifier 59. only if no more descriptive modifier is available, and the use of modifier 59 best explains the circumstances, should modifier 59 be used. note: modifier 59 should not be appended to an e/m service. to report a separate and distinct e/m service with a non-e/m service performed on the same date, see modifier 25.
GC This service has been performed in part by a resident under the direction of a teaching physician
XU Unusual non-overlapping service, the use of a service that is distinct because it does not overlap usual components of the main service
51 Multiple procedures: when multiple procedures, other than e/m services, physical medicine and rehabilitation services or provision of supplies (eg, vaccines), are performed at the same session by the same individual, the primary procedure or service may be reported as listed. the additional procedure(s) or service(s) may be identified by appending modifier 51 to the additional procedure or service code(s). note: this modifier should not be appended to designated "add-on" codes (see appendix d).
KX Requirements specified in the medical policy have been met
RT Right side (used to identify procedures performed on the right side of the body)
22 Increased procedural services: when the work required to provide a service is substantially greater than typically required, it may be identified by adding modifier 22 to the usual procedure code. documentation must support the substantial additional work and the reason for the additional work (ie, increased intensity, time, technical difficulty of procedure, severity of patient's condition, physical and mental effort required). note: this modifier should not be appended to an e/m service.
47 Anesthesia by surgeon: regional or general anesthesia provided by the surgeon may be reported by adding modifier 47 to the basic service. (this does not include local anesthesia.) note: modifier 47 would not be used as a modifier for the anesthesia procedures.
52 Reduced services: under certain circumstances a service or procedure is partially reduced or eliminated at the discretion of the physician or other qualified health care professional. under these circumstances the service provided can be identified by its usual procedure number and the addition of modifier 52, signifying that the service is reduced. this provides a means of reporting reduced services without disturbing the identification of the basic service. note: for hospital outpatient reporting of a previously scheduled procedure/service that is partially reduced or cancelled as a result of extenuating circumstances or those that threaten the well-being of the patient prior to or after administration of anesthesia, see modifiers 73 and 74 (see modifiers approved for asc hospital outpatient use).
53 Discontinued procedure: under certain circumstances, the physician or other qualified health care professional may elect to terminate a surgical or diagnostic procedure. due to extenuating circumstances or those that threaten the well being of the patient, it may be necessary to indicate that a surgical or diagnostic procedure was started but discontinued. this circumstance may be reported by adding modifier 53 to the code reported by the individual for the discontinued procedure. note: this modifier is not used to report the elective cancellation of a procedure prior to the patient's anesthesia induction and/or surgical preparation in the operating suite. for outpatient hospital/ambulatory surgery center (asc) reporting of a previously scheduled procedure/service that is partially reduced or cancelled as a result of extenuating circumstances or those that threaten the well being of the patient prior to or after administration of anesthesia, see modifiers 73 and 74 (see modifiers approved for asc hospital outpatient use).
58 Staged or related procedure or service by the same physician or other qualified health care professional during the postoperative period: it may be necessary to indicate that the performance of a procedure or service during the postoperative period was: (a) planned or anticipated (staged); (b) more extensive than the original procedure; or (c) for therapy following a surgical procedure. this circumstance may be reported by adding modifier 58 to the staged or related procedure. note: for treatment of a problem that requires a return to the operating/procedure room (eg, unanticipated clinical condition), see modifier 78.
76 Repeat procedure or service by same physician or other qualified health care professional: it may be necessary to indicate that a procedure or service was repeated by the same physician or other qualified health care professional subsequent to the original procedure or service. this circumstance may be reported by adding modifier 76 to the repeated procedure or service. note: this modifier should not be appended to an e/m service.
77 Repeat procedure by another physician or other qualified health care professional: it may be necessary to indicate that a basic procedure or service was repeated by another physician or other qualified health care professional subsequent to the original procedure or service. this circumstance may be reported by adding modifier 77 to the repeated procedure or service. note: this modifier should not be appended to an e/m service.
78 Unplanned return to the operating/procedure room by the same physician or other qualified health care professional following initial procedure for a related procedure during the postoperative period: it may be necessary to indicate that another procedure was performed during the postoperative period of the initial procedure (unplanned procedure following initial procedure). when this procedure is related to the first, and requires the use of an operating/procedure room, it may be reported by adding modifier 78 to the related procedure. (for repeat procedures, see modifier 76.)
79 Unrelated procedure or service by the same physician or other qualified health care professional during the postoperative period: the individual may need to indicate that the performance of a procedure or service during the postoperative period was unrelated to the original procedure. this circumstance may be reported by using modifier 79. (for repeat procedures on the same day, see modifier 76.)
80 Assistant surgeon: surgical assistant services may be identified by adding modifier 80 to the usual procedure number(s).
AQ Physician providing a service in an unlisted health professional shortage area (hpsa)
AS Physician assistant, nurse practitioner, or clinical nurse specialist services for assistant at surgery
CR Catastrophe/disaster related
ET Emergency services
FS Split (or shared) evaluation and management visit
GV Attending physician not employed or paid under arrangement by the patient's hospice provider
GW Service not related to the hospice patient's terminal condition
LT Left side (used to identify procedures performed on the left side of the body)
Q0 Investigational clinical service provided in a clinical research study that is in an approved clinical research study
Q1 Routine clinical service provided in a clinical research study that is in an approved clinical research study
Q6 Service furnished under a fee-for-time compensation arrangement by a substitute physician or by a substitute physical therapist furnishing outpatient physical therapy services in a health professional shortage area, a medically underserved area, or a rural area
SA Nurse practitioner rendering service in collaboration with a physician
X3 Episodic/broad services: for reporting services by clinicians who have broad responsibility for the comprehensive needs of the patient that is limited to a defined period and circumstance such as a hospitalization; reporting clinician service examples include but are not limited to the hospitalist's services rendered providing comprehensive and general care to a patient while admitted to the hospital
X4 Episodic/focused services: for reporting services by clinicians who provide focused care on particular types of treatment limited to a defined period and circumstance; the patient has a problem, acute or chronic, that will be treated with surgery, radiation, or some other type of generally time-limited intervention; reporting clinician service examples include but are not limited to, the orthopedic surgeon performing a knee replacement and seeing the patient through the postoperative period
XE Separate encounter, a service that is distinct because it occurred during a separate encounter
XP Separate practitioner, a service that is distinct because it was performed by a different practitioner
XS Separate structure, a service that is distinct because it was performed on a separate organ/structure
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2017-01-01 Changed Moderate (Conscious) Sedation flag removed. See new Moderate Sedation category.
Pre-1990 Added Code added.
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