Cardiology Coding Alert

Question: Although the Federal Register indicates a 90-day global for permanent pacer insertion (33206, for example), our physician believes its OK to charge for the one-month analysis/reprogramming (93735). Is he correct?

Vermont Subscriber

Answer: In this case, Only your carrier knows for sure, says Susan Callaway, CPC, CCS-P, an independent coding and reimbursement specialist and educator in North Augusta, S.C. There are many opinions on this matter, but no authoritative payment guidelines which leaves the carriers to determine whether the pacer analysis is payable or not.

Because the example used is 33206 (insertion or replacement of permanent pacemaker with transvenous electrode[s]; atrial), we can assume a single-chamber pacer was inserted.

The Medicare Coverage Issues Manual states that two in-clinic evaluations may be performed in the first six months after insertion. This appears to contradict Medicares surgical package guidelines, under which the pacer analysis performed four weeks after the insertion would seem to be included in the insertions global period.

Some coders resolve the dilemma by assuming the guidelines should be applied only after the end of the global period. In other words, the two covered in-clinic visits would occur in the six months following the end of the global period. Others claim the two checks should be performed during the final three months that follow the end of the global period.

The American College of Cardiology has expressed the view that the pacers global period does not apply to pacer checks at all, but only to wound complications or other problems related to the opening and closing of the patient. But again, in the absence of any written payment policies, carriers have complete discretion to determine whether the checks are covered.