Question: If the cardiologist performs a pacemaker insertion in the hospital and later visits the patient in observation, should I code the observation visit?
Answer: You should not charge this visit separately. Pacemaker insertion code 33208 (Insertion or replacement of permanent pacemaker with transvenous electrode[s]; atrial and ventricular) has a 90-day global period.
For payers applying Medicare rules, that means that payment for the pacemaker insertion service includes the following services (among others) for 90 days following the procedure:
- Services related to complications following surgery, not requiring additional trips to the operating room
- Postoperative visits (follow-up visits) related to recovery from the surgery
- Postsurgical pain management by the surgeon.
FYI: Medicare specifies certain visits that are not included in the global package, meaning you may report them separately:
- Visits unrelated to the diagnosis that prompted the surgical procedure (unless the visits occur due to complications)
- Treatment for the underlying condition or an added course of treatment which is not part of normal surgery recovery
- Diagnostic tests and procedures
- Clearly distinct surgical procedures which are not re-operations or treatment for complications
- Treatment for complications which requires a return trip to the operating room.
When an E/M service occurs during a postoperative global period for reasons unrelated to the original procedure, you should append modifier 24 (Unrelated evaluation and management service by the same physician during a postoperative period) to the appropriate E/M code.
@ Cardiology Coding Alert. Editor: Deborah Dorton, JD, MA, CPC
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