Check 33208 global to avoid Evaluation & Management snafu

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

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.