Cardiology Coding Alert

Question: When a patient returns for suture removal following pacemaker insertion, can we charge an E/M code for the visit?

Iowa Subscriber

Answer: You should consider the suture removal bundled into the pacemaker insertion, and therefore you should not charge separately for the visit. Pacemaker insertion codes 33206- 33208 (Insertion or replacement of permanent pacemaker with transvenous electrode[s] ...) have a global period of 90 days, meaning the 24 hours before surgery and 90 days following surgery.

On the other hand: If the patient returned to see the cardiologist for an unrelated problem during those 90 days, you could report that service separately. For example, if the cardiologist provided a level-three established patient E/M in the office for a problem unrelated to the pacemaker insertion, you should report 99213 (Office or other outpatient visit for the evaluation and management of an established patient ...) and append modifier 24 (Unrelated evaluation and management service by the same physician during a postoperative period) to indicate the unrelated nature of the service.