# pacemaker global



## MILLINRP (Sep 29, 2008)

I am new to cardiology and need information on when it is and is not appropriate to apply the a-24 modifier and bill for a hospital visit outside the global package.


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## FTessaBartels (Sep 30, 2008)

*UNrelated E/M*

Cardiology is *NOT* my area of expertise, but CPT guidelines are pretty specific.

In order to use the -24 modifier, the visit must be for a "*reason unrelated to the original procedure*." (Quote from Appendix A, 2008 CPT Professional Edition, pg 457)

I would think that most anything dealing with arrhythmia or other cardiac difficulties would be considered RELATED to the pacemaker placement and covered in the global period.

Do you have a specific scenario that you are questioning?

F Tessa Bartels, CPC, CPC-E/M


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## Davistm (Oct 16, 2008)

To expand on the previous response.

The 90 day global for PM/ICD insertion is for the surgical portion of the procedure and is not applicable to the functioning of the devise itself.  If the patient experiences any heart rhytym symptoms within the 90 day global period, the ensuing E/M services would fall under post-operative care.

However, cardiac symptoms such as chest pain, syncope, angina, shortness of breath, etc. may not have an arrythmia etiology and the associated E/M services would be separately reportable.  Same for CAD, MI or other cardiomyopathies.

If your in doubt, ask the physician.

Terry Davis
CPC


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