Correctly Bill Pacemaker Checks During the Global Period
Published on Wed Mar 01, 2000
"Cardiologists need to familiarize themselves with the guidelines on pacemaker checks after a pacer has been installed in a patient. Because the insertion of a pacer is one of the few procedures cardiologists perform that has a 90-day global period, some cardiologists unfamiliar with global package guidelines have been billing for visits when all they do is perform a pacer check, especially if they are performing more checks than Medicare guidelines allow. Others, meanwhile, may inadvertently bill for a pacer check or an office visit, or both, when neither is appropriate. Alternatively, they may not bill the check or the visit even when doing so may be correct.
To correctly code such checks and visits, cardiologists need to understand both global surgery guidelines and the rules governing pacemaker installation and analysis. There are several implantation and replacement codes for pacemakers (3320x, 3321x), depending on whether the device is a single- or dual-chamber pacer, among other things. Typically, after any of these devices is installed, the patient returns within seven to 10 days so the cardiologist can check the function of the pacemaker and the patients condition after the surgery. Normally, such visits are included in the pacemaker insertions global period, but there are several situations in which the cardiologist can bill for the visit, the pacemaker check or both.
Pacemaker Check Guidelines
Medicare allows payment for two pacemaker checks in the first six months after installation of a single-chamber pacemaker, and one check every 12 months after that. For dual-chamber pacers, one check every six months is allowed after the first six months. These guidelines apply after the 90-day global period has ended. So in many cases, the pacer check performed within 10 days after implantation is included in the global package.
For example, if a 68-year-old male patient has a pacemaker inserted and 10 days later returns for a routine follow-up visit and pacer check, neither is billable because both services are part of the pacemaker insertions global package. The removal of staples (or sutures) at that time is not billable, nor is checking the wound or even a minor skin infection caused by the original procedure.
This is tough for cardiologists because its the only procedure they perform that has a 90-day global period, says Sandy Fuller, a coder with Cardiology Consultants, a group practice in Abilene, Texas. They arent used to billing with a surgical package. Normally, everything they do on separate days is billed.
You cant bill for a visit when all you did was a pacer check, Fuller says, adding that checking the pacers programming [...]
