Cardiology Coding Alert

Question: If the cardiologist performs a pacemaker insertion in the hospital and later visits the patient in observation, should I code the observation visit?

Georgia Subscriber

Answer: You should not charge this visit separately. Pacemaker insertion code 33208 (Insertion or replacement of permanent pacemaker with transvenous electrode[s]; atrial and ventricular) has a 90-day global period.

For payers applying Medicare rules, that means that payment for the pacemaker insertion service includes the following services (among others) for 90 days following the procedure:

• Services related to complications following surgery, not requiring additional trips to the operating room

• Postoperative visits (follow-up visits) related to recovery from the surgery

• Postsurgical pain management by the surgeon.

FYI: Medicare specifies certain visits that are not included in the global package, meaning you may report them separately:

• Visits unrelated to the diagnosis that prompted the surgical procedure (unless the visits occur due to complications)

• Treatment for the underlying condition or an added course of treatment which is not part of normal surgery recovery

• Diagnostic tests and procedures

• Clearly distinct surgical procedures which are not re-operations or treatment for complications

• Treatment for complications which requires a return trip to the operating room.

When an E/M service occurs during a postoperative global period for reasons unrelated to the original procedure, you should append modifier 24 (Unrelated evaluation and management service by the same physician during a postoperative period) to the appropriate E/M code.

Source: You can find the definition of the global surgical package in Medicare Claims Processing Manual, Chapter 12, Section 40.1.A (www.cms.hhs.gov/Manuals/IOM/list.asp).

-- You Be the Coder and Reader Questions prepared with the assistance of Jim Collins, CPC, CCC, CHCC, president of www.CardiologyCoder.Com.A