Implementation of the Pacemaker NCD has been delayed.

The new National Coverage Determination (NCD) for Single Chamber and Dual Chamber Cardiac Pacemakers has been delayed (it was supposed to go into effect today). The new implementation date has not been announced at this time.

Full Announcement from Novitas Solutions:

Q & A with Dr. David Zielske

Question: Permatemp Pacemaker Placed Post TAVR

Recently our cardiologists have started prophylactically inserting a "permatemp pacemaker" at the end of all TAVR procedures as part of a new guideline (I'm not sure whether this is an internal policy or a new guideline for standard of care on all TAVR procedures). If no significant heart block develops, they are removed later.

I feel that we should not bill for prophylactic care and that codes 33216 and 33234 should only be billed when the patient is documented as having heart block necessitating the continued pacing after removal of the pacing wire/balloon used during the TAVR. What are your thoughts?

From CMS:

IMPLEMENTATION DATE July 7, 2014: When a permanent pacemaker is implanted, there must be an attestation that there is documentation on file that the patient has non-reversible symptomatic bradycardia (symptoms of bradycardia are symptoms that can be directly attributable to a heart rate less than 60 beats per minute (for example: syncope, seizures, congestive heart failure, dizziness, or confusion)), as this is the only diagnosis that meets the NCD coverage requirements.