Part B Insider (Multispecialty) Coding Alert

Study up on the global package to make sure you don't miss payable services

Question: Our cardiologist implants pacemakers, which have a 90-day global period. I know that x-rays are paid for during the global period of orthopedic surgery. Does Medicare pay for an EKG during the global period? 

Answer: All diagnostic tests in the global period are separately payable, says Jan Rasmussen with Professional Coding Solutions in Eau Claire, WI.

Pacemaker and defibrillator implantations are considered -major- surgical procedures, says Jim Collins, president of The Cardiology Coalition in Saratoga Springs, NY. These do have 90-day global periods. But the global package includes only:

- preoperative visits after the decision to operate
- intra-operative services and the surgery itself
- post-operative complications that don't require a return to the operating room
- follow-up visits that are related to recovery from the surgery, plus supplies and pain management.

Chapter 12 of the Medicare Carriers Manual also clarifies that the global period doesn't include an initial consultation to determine the need for surgery, unrelated visits, treatment for the underlying condition which is not part of the normal recovery from surgery, clearly distinct surgical procedures, post-op complications which require a return to the OR, and unrelated critical care.

The manual also includes -diagnostic tests and procedures- among the separately covered services, says Collins.

EKGs, x-rays and device interrogations are all considered diagnostic tests, Collins adds. So you can always bill them separately after a procedure.

Exception: If the physician is doing the EKG as part of a device check, then the EKG is included in the payment for the device check, says Jennifer Crowell with Spokane Cardiology in Spokane, WA. You should look for a separate indication, such as chest pain, fatigue or some other new situation, says Crowell.