Check 33208 Global to Prevent E&M Snafu

When an EM service occurs during a postop global period for reasons unrelated to the original procedure, use this modifier.

Question: If the cardiologist performs a pacemaker insertion in the hospital and later visits the patient in observation, should I...

When an EM service occurs during a postop global period for reasons unrelated to the original procedure, use this modifier.

Question: If the cardiologist performs a pacemaker insertion in the hospital and later visits the patient in observation, should I code the observation visit?

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Georgia Subscriber

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.

Source: You can find the definition of the global surgical package in Medicare Claims Processing Manual, Chapter 12, Section 40.1.A.

Cardiology Coding Alert. Editor: Deborah Dorton, JD, MA, CPC

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