Cardiology Coding Alert

Question: We have a patient who was seen in consultation, and on the same day the cardiologist placed a temporary pacemaker. The next day the cardiologist placed a permanent pacemaker. Do I need any modifiers for the following day when the cardiologist placed the permanent pacemaker?

New Mexico Subscriber

Answer: You don't need to apply any additional modifiers to the cardiologist's placement of the permanent pacer (such as, 33208), because the placement of the temporary pacer (33210, Insertion or replacement of temporary transvenous single chamber cardiac electrode or pacemaker catheter [separate procedure]) has a zero-day global.

A zero-day global means that the preoperative or post-operative care period begins and ends on the day of the surgery. You should include every related E/M service the cardiologist provides on the day of the surgery. This is different from "no global period," in which you can separately report E/M services on the same day. A zero-day global equals one global day, the date of the procedure. Therefore, the permanent pacemaker implantation would fall outside of this global period.