From Supercoder.com:
Checking Mechanical Problems Is Billable
If the cardiologist suspects the pacemaker has a mechanical problem, then checking the device can be billed, Fuller says. You are checking the mechanical function of a piece of equipment, not your own work. If the pacemaker is faulty, that is not the cardiologists responsibility. Therefore, checking it is a billable service, she says.
According to guidelines set forth by Palmetto Government Benefits Administrators, the Medicare Part B carrier in South Carolina, Pacemaker monitoring frequency exceeding [the guidelines outlined above] will be reviewed on a prepayment basis. Documentation must support the medical necessity of more frequent monitoring. This would include, but is not limited to: lightheadedness, dizziness, vertigo (780.4), chest pain (786.50), syncope (780.2), atrial fibrillation (427.31), atrial flutter (427.32), unusual confusion (298.9), tachycardia (785.0), PVCs (427.60), lethargy (780.79) or any signs/symptoms of failure of synchronization of atria and ventricles in cases of dual chamber pacemakers.
In other words, mechanical problems with the pacemaker are an exception to these guidelines and should be so noted by providing documentation to the carrier to that effect when the claim is filed. If the documentation is not included, the claim likely will be denied and the documentation will have to be submitted on appeal.
For example, a female patient who had a pacer installed 10 days earlier may visit the cardiologist complaining of little shocks. The cardiologist suspects the pacer is not functioning correctly, possibly due to a lead touching an area it shouldnt. In that situation, the cardiologist can bill for the pacer check. Repair of the pacemaker, if required, will fall under the original implantations global period, but the check does not.
As Per CMS guidelines, Following Procedure should not be billed separately within the global period:
- Preoperative visits after the decision is made to operate, beginning with the day
- All intra-operative services that are usual and necessary parts of a surgical procedure
- Follow-up visits during the surgery's postoperative period that are related to recovery from the surgery
- Postsurgical pain management by the surgeon
HTH
