Cardiology Coding Alert

Question: What services are included in pacemaker and internal cardioverter-defibrillator (ICD) implant global periods? Which E/M services can I report separately?

Washington Subscriber

Answer: Pacemaker and ICD implants have 90-day global periods. If your cardiologist performs patient assessments one day before and 90 days after a scheduled implant, these services are part of the main procedure codes and you would not bill them separately. You would also not bill separately for admits, discharges or follow-up office visits for such services as wound checks during the 90-day post-op period.
 
If the cardiologist made the decision to operate the day of the implant or the day before, you can report the appropriate E/M code, such as 99254 (Initial inpatient consult ...), and append modifier -57 (Decision for surgery) if the E/M service resulted in the initial decision for surgery. If the patient had a diagnostic service, such as an electrocardiogram (93010, Electrocardiogram, routine ECG with at least 12 leads; interpretation and report only), prior to the surgery, you would append modifier -59 (Distinct procedural service) to the appropriate EKG code.
 
When a patient with an implant presents with a problem unrelated to the pacer or ICD, such as hypertension or cardiomyopathy (401.9 or 425.4), you can bill for that service during the post-op period. Append modifier -24 (Unrelated evaluation and management service by the same physician during a postoperative period) to indicate that the physician who performed the implant also provided an E/M service unrelated to the procedure. You should also make sure that the physician lists a different diagnosis for this E/M so that payers can easily distinguish the service from the implant.