Wiki Billing pacemakers/ICD's/physiology monitors

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liherman

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Hi. I'm new to coding and billing of pacemakers, icd's and physiology monitors. I am a bit confused by the wording. It says not to bill until the 91st day for both pacers and icd's because of the 90 day global but yet it says do not bill before 30 days. Can you bill before that 91st day? Same with physiology studies. They should be billed every 31 days as there is a 30 day global but it says not to bill before 10 days. And what is considered a "service center". (These interrogations/programmings are performed through a pacemaker clinic) Thank you.
 
I hope I can help you. First, the service center is where the procedure was done, example, hospital, office-based labs (OBL), off-campus outpatient hospital. As for the other procedures, you can bill for the pacemaker insertion just after the procedure is performed. It's the pacemaker/ICD checks that can only be done/ billed after the 90-day global period. If the patient comes to the office for a problem not related to the pacemaker/ ICD/ monitors, that visit is billable.
 
Jim Pawloski said:
I hope I can help you. First, the service center is where the procedure was done, example, hospital, office-based labs (OBL), off-campus outpatient hospital. As for the other procedures, you can bill for the pacemaker insertion just after the procedure is performed. It's the pacemaker/ICD checks that can only be done/ billed after the 90-day global period. If the patient comes to the office for a problem not related to the pacemaker/ ICD/ monitors, that visit is billable.
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Ok. But each time a pacemaker/icd check is performed it can only be done every 90 days correct? So those procedures would be billed on the 91st day. And the same thing with the physiology monitors (only with those it would be billed on the 31st day) So if a patient has a remote interrogation on say 5/1/23 and they have another one on 7/14/23 (both are normal) the second one cannot be billed correct cause it is within that 90 global day window? Same situation but the patient may only be 4-6 days before the full 90 days so that still cannot be billed right?
 
I would try billing for it in the 4-6 day window, as the patient's availability for the check may interfere with 90 day rule.
 
The interrogations must be done every 91 or 31 days, no exceptions. if these are remote interrogations, the patient availability is not relevant. Our cardiologists have been performing and billing for remote interrogations for several years and if the interrogation is done within the 90 or 30 day global period, we will not bill for it.

Hope this helps.
 
liherman said:
Ok. But each time a pacemaker/icd check is performed it can only be done every 90 days correct? So those procedures would be billed on the 91st day. And the same thing with the physiology monitors (only with those it would be billed on the 31st day) So if a patient has a remote interrogation on say 5/1/23 and they have another one on 7/14/23 (both are normal) the second one cannot be billed correct cause it is within that 90 global day window? Same situation but the patient may only be 4-6 days before the full 90 days so that still cannot be billed right?
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Thank you.
 
deeva456 said:
The interrogations must be done every 91 or 31 days, no exceptions. if these are remote interrogations, the patient availability is not relevant. Our cardiologists have been performing and billing for remote interrogations for several years and if the interrogation is done within the 90 or 30 day global period, we will not bill for it.

Hope this helps.
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Thank you very much for the information.
 
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