Cardiology Coding Alert
Integumentary System
Pennsylvania Subscriber
Answer: This is a good example of how "cardiology tunnel vision" that is, the tendency to research cardiology-related codes, e.g., codes in the "Pacemaker or Pacing Cardioverter-Defibrillator" section of the CPT manual, without researching other codes can inhibit the selection of a billable code.
The procedure described is not a true pocket revision 33222 (revision or relocation of skin pocket for pacemaker) which involves physically moving the pocket.
Because the cardiologist has performed an incision and drainage of a postoperative wound infection, 10180 (incision and drainage, complex, postoperative wound infection) would apply.
Because all the pacemaker implantation codes 33206 (insertion or replacement of permanent pacemaker with transvenous electrode[s]; atrial), 33207 (... ventricular) and 33208 (... atrial and ventricular) have 90-day global periods, append modifier -78 (return to the operating room for a related procedure during the postoperative period) to 10180 (a return to the catheterization lab is considered a return to the operating room).
Note: Medicare considers complications that result from a surgical procedure part of the global surgical package and permits separate payment for treating complications only if the patient returns to the operating room. However, CPT's newly introduced definition of a surgical package (found in the "Surgery Guidelines" preceding the "Surgery" section of CPT 2002) does not include complications, and many private payers may not consider the treatment of a complication to be a related procedure. In such cases, the carrier may require modifier -79 (unrelated procedure or service by the same physician during the postoperative period) or no modifier at all for the incision and drainage.
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