Cardiology Coding Alert

Question: My cardiologist inserted a pacemaker into a patient at the hospital. After a month, the patient returns to our office for a follow-up on the pacemaker, and our doctor did a pacemaker check. Will Medicare pay an office visit follow-up in addition to the pacemaker check?

South Carolina Subscriber

Answer: If you can show how the E/M service was unrelated to the pacemaker implantation, you can report this service separately with the applicable E/M code (99211-99215) and append modifier -24 (Unrelated evaluation and management service by the same physician during a postoperative period).
 
However, as a rule, you should avoid separate billing for wound checks and routine postoperative E/M services during the 90-day postoperative period.
 
Note: According to Medicare, you should use the V code (such as V45.01, Cardiac device in situ; cardiac pacemaker or V53.31, Cardiac device, reprogramming; cardiac pacemaker) as the primary diagnosis for routine device checks.
 
This may lead to some problems with commercial companies because of faulty edits. If this is the case, try using the implant diagnosis (426.10, Atrioventricular block, unspecified) and then the V codes.