Cardiology Coding Alert
Pacer Pocket Treatment
California Subscriber
Answer: The procedure you describe is not a true pocket revision - 33222 (Revision or relocation of skin pocket for pacemaker) - which typically involves physically moving the generator to a new pocket.
Because the cardiologist performed an incision and drained a postoperative wound infection, you could report 10180 (Incision and drainage, complex, postoperative wound infection).
All the pacemaker implantation codes - 33206 (Insertion or replacement of permanent pacemaker with transvenous electrode[s]; atrial), 33207 (... ventricular) and 33208 (... atrial and ventricular) - have 90-day global periods, so you should append modifier -78 (Return to the operating room for a related procedure during the postoperative period) to 10180 because you would bill a return to the catheterization lab the same as a return to the operating room.
Medicare considers complications from a surgical procedure part of the global surgical package and permits separate payment when physicians treat complications only if the patient returns to the operating room. But CPT's definition of a surgical package (found in the "Surgery Guidelines" preceding the "Surgery" section of CPT 2003) does not include complications, and many private payers may not consider the complication treatment to be a related procedure.
Cardiology Coding Alert
- Streamline Your IVUS Coding With 3 Tips
Experts explain how to recoup your practice's ultrasound pay
When cardiologists perform intravascular ultrasounds (IVUS) [...] - E/M Audit Results, Part 3:
4 Strategies Help You Sharpen Your MDM Tool Skills - You Be the Coder:
Pacer Pocket Treatment
Question: A patient who had a pacemaker implanted on Sept. 15 returned to the hospital [...] - E/M Audit Results, Part 3:
How's Your MDM Coding Accuracy? Read What Your Peers Say
If you're having trouble pinning down the right level of medical decision-making (MDM), you're not [...] - Correction and Additions:
Peripheral Vascular Case Study: What You Need to Know
In the October 2003 Cardiology Coding Alert, the article "Peripheral Vascular Case Study: Get [...] - Reader Question:
Use Coumadin Therapy to Support Test
Question: Patients often come in for a Protime test with a diagnosis of "Coumadin therapy." [...] - Reader Question:
Don't Apply SPECT Codes for Extremities
Question: One of our physicians performed a thallium scan of a lower extremity with SPECT [...] - Reader Question; Avoid Modifier -51 for EP Studies
Question: Which modifiers should we use when reporting intracardiac electrophysiological studies (EPS)?
Tennessee Subscriber Answer: CPT [...] - Reader Question:
Append Modifier -55 for Cardiologist's Post-Op Care
Question: Often, when our cardiac surgeon performs a surgical procedure, another cardiologist in our practice [...]
