Check 33208 Global To Avoid Evaluation & Management Snafu

By Author: Nancy Rose
Total Articles: 53
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Question: If the cardiologist carries out a pacemaker insertion in the hospital and later visits the patient in observation, should I report the observation visit?


Answer: You shouldn't charge this visit separately. Pacemaker insertion code 33208 (Insertion or replacement of permanent pacemaker with transvenous electrode[s]; atrial and ventricular) has got a 90-day global period.


For payers applying Medicare rules that means that payment for the pacemaker insertion service covers the following services for 90 days following the procedure:


Services pertaining to complications post surgery, not requiring additional trips to the operating room.
Postoperative visits (follow-up visits) pertaining to recovery from the surgery
Postsurgical pain management by the surgeon.
FYI: Medicare specifies some visits that are not covered in the global package, meaning you may report them separately:


Visits not related to the diagnosis that lead to the surgical procedure (unless the visits take place owing to complications)
Treatment for ...
... the underlying condition or an added course of treatment which isn't part of normal surgery recovery
Diagnostic procedures and tests
Clearly separate surgical procedures which are not re-operations or treatment for complications
Treatment for complications which calls for a return trip to the operating room.


When an evaluation & management service takes place during a postoperative global period for reasons unrelated to the original procedure, you should go for modifier 24 (Unrelated evaluation and management service by the same physician during a postoperative period) to the right E/M code.