Cardiology is NOT my area of expertise, but CPT guidelines are pretty specific.
In order to use the -24 modifier, the visit must be for a "reason unrelated to the original procedure." (Quote from Appendix A, 2008 CPT Professional Edition, pg 457)
I would think that most anything dealing with arrhythmia or other cardiac difficulties would be considered RELATED to the pacemaker placement and covered in the global period.
Do you have a specific scenario that you are questioning?
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