pacemaker insertion and closure

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:confused: Hi everyone,

I am at risk with Humana Medicare and audit all claims that come through my office from the specialists. I have a cardiologist who billed a pacemaker insertion and then billed the closurer of the incision seperately and was paid by Humana. I contested this claim, but it was rejected. It is proper coding to bill the pacemaker insertion along with the closure 12032. Please let me know if this is unbundling.

Thank you all,

Linda Umlah, CPC
 

ARCPC9491

True Blue
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Hello, I've had the same issue before and was rejected too.

Closure is normally included in the procedure - think of it this way, "if you open it, you have to close it" So payers don't feel like they should have to pay you seperately.

Also, "revision of skin pocket" billed in conjunction with a pacemaker procedure, for most payers, I have found, is bundled as well.

Unless, for example, it's a reconstructive closure that is much more complex.

But, I haven't seen this for pacemakers.

If something is extensive/complicated, i.e. obese pt...you could always pop a modifier 22 and get a little extra.

Hope this helps.:D
 
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