Cardiology Coding Alert

Question: Surgery is done to implant a defibrillator (33249). Intraoperative-device testing (93641) had to be terminated prematurely because of patient instability, and therefore we appended modifier -53 to 93641. When the patient stabilized, he was brought back during the global period for device testing to ensure proper function (93642). Which modifier (-58, -78 or -79) should we append to 93642? Please note that testing of the device to ensure proper function is not a part of the surgery and is not being done as a result of a surgical complication.

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Answer: Modifier -79 (unrelated procedure or service by the same physician during the postoperative period) should be appended to 93642 (electrophysiologic evaluation of single or dual chamber pacing cardioverter-defibrillator [includes defibrillation threshold evaluation, induction of arrhythmia, evaluation of sensing and pacing for arrhythmia termination, and programming or reprogramming of sensing or therapeutic parameters]) to indicate that the evaluation of the defibrillator is separate from the implantation procedure, i.e., unrelated. Similar to 93641 (... with testing of single or dual chamber pacing cardioverter-defibrillator pulse generator) the code used to describe the evaluation that was attempted, then discontinued on the day of the implantation 93642 is payable separately because evaluation of pacers or internal cardioverter-defibrillators is considered unrelated to the implantation of these devices.
The answers to You Be the Coder and Reader Questions were provided by Sueanne Bicknell, RRA, CPC, CCSP, compliance administrator with CPR/Heart Place, a 60-physician practice in Dallas; Susan Callaway, CPC, CCS-P, a coding and reimbursement specialist and educator in North Augusta, S.C.; Kathleen Mueller, RN, CPC, CCS-P, a coding and reimbursement specialist in Lenzburg, Ill.; Sandy Rubio, RN, CPC, a cardiology coding and reimbursement specialist in Omaha, Neb.; Nikki Vendegna, CPC, a cardiology coding and reimbursement specialist in Overland Park, Kan.; and Marko Yakovlevitch, MD, FACP, FACC, a cardiologist in private practice in Seattle.