You Be the Coder:
Pacer Pocket Treatment
Published on Wed Nov 05, 2003
Question: A patient who had a pacemaker implanted on Sept. 15 returned to the hospital with "oozing from the pocket" on Oct. 7. The patient went to the catheterization lab for hematoma evacuation. The cardiologist made a second incision over the top of the first one, performed hematoma evacuation, flushed and cleaned the pocket, put the device back and closed the pocket. Is this a pocket revision? How should we code this?
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.
