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?


I would not submit a code for prophylactic placement of a pacemaker. New guidelines specifically do not allow treatment with a pacemaker to be paid unless irreversible bradycardia is present (see NCD 20.8 update: requiring the -KX modifier to be applied to any pacemaker code, meaning that the physician is attesting to the fact that the patient has “irreversible symptomatic bradycardia”, will be a NEW requirement for payment for pacemaker placements).

So, again, in this case, I would not submit a code for this procedure. I would just consider it part of the TAVR.