Global Period / Global Surgery period / Global surgery package – As per
Medicare guidelines, any minor or major surgery includes all the pre-operative,
intra-operative and post-operative routine care related to the original surgery
and those services should not be reported separately for reimbursement.
Note: Pre / Intra / Postoperative care performed by the same
surgeon or same group with the same speciality are considered as same.
There are three types of surgery global period based on the
number of postoperative days; each surgery CPT code has a global period status
indicator.
1. Zero Days (000) – Some minor
surgeries have zero global periods status
- No
Pre (or) Postoperative days.
- Generally,
E&M would be included and is not payable separately on the same day of
surgery.
- Eg:
Endoscopy procedures
2. 10 Days (010) – Minor surgery with 10
days postoperative period
- No
preoperative period
- A
total global period is 11 days (Including surgery date followed by 10
postoperative days).
- E&M
would be included and is not payable separately on the same day of surgery as
well as during the postoperative 10 days of the global period. Use 99024
(Postoperative E&M / follow up visit) which is zero dollar CPT.
- Eg.
Incision and drainage
3. 90 Days (090) – Major surgery with 90
days postoperative period
- A
total global period is 92 days (One day for preoperative, one day for surgery
day and postoperative 90 days)
- Follow
up office visit on the postoperative 90 days are not payable.
Apart from the above mentioned three global periods we have
other status indicators are given below but global period concepts don’t apply
1. XXX – CPT’s like
Radiology, pathology, Anesthesia, & E/M (Global period concepts doesn’t
apply)
2. YYY – Unlisted codes
(Global period concepts doesn’t apply)
3. ZZZ – Add-on codes (+)
must bill with primary service.
4. MMM – For Maternity codes.
(Global period concepts doesn’t apply)
Global surgery package includes,
1. E&M visit result in surgery,
same day for minor surgery and also the pre-op day for major surgery.
2. Intraoperative services
3. All additional related
services during the global period following surgery.
- Follow
up visits
- Post
surgery pain management
- Dressing
change, suture removal tubes changes and removal.
Note: The E&M for minor surgical procedures on the same day
is always included in the global surgery package. Unless a significant,
separately identifiable service is also performed. Then append Modifier 25 to
bill the separately identifiable E/M service performed by the same physician on
the same day of the procedure.
Global surgery excluded services,
1. Initial consultation or
E/M visit to determine major surgery is payable, Append modifier 57 with E/M
and submit the claim.
2. E/M Visits unrelated to
the surgery. (Different diagnosis)
3. Treatment/procedures which
are not part of normal recovery from the original surgery.
4. Services by another
physician due to the transfer of care with proper agreement letter in the discharge
summary.
Appending appropriate modifier would help in proper
reimbursement during the global surgical period.
Modifier 25 – E/M on the same
day with minor surgery but separately identifiable E/M service.
Modifier 57 – on the same day
or preoperative day office visit with major surgery.
Modifier 24 – Any
unrelated office visit during the postoperative period
Example: Generally Fracture reduction CPT would have 90 days
global period, and any unrelated condition like abdomen pain Evaluation during
the global period would be separately payable, Append modifier 24 with the
postoperative E/M visit and submit the claim.
Upper extremity Incision and drainage CPT would have 10 days
global period and any unrelated condition like leg pain evaluation during the global period would be separately payable, Append modifier 24 with the
postoperative E/M visit and submit the claim.
Modifier 58, 78 and 79 with
surgery codes during the postoperative period.
Example: Any surgery performed during the postoperative global
period as a staged procedure of the original procedure (Staged or related
procedure or service by the same physician during the postoperative period)
append modifier 58 and submit the claim.
Surgery performed during the postoperative global period to
treat the complication of original surgery (Unplanned return to the operating
room by the same physician following the initial procedure for a related
procedure during the postoperative period) append modifier 78 and submit the
claim.
Surgery performed during the postoperative global period to treat
the unrelated or different condition from the original surgery (Unrelated
procedure by the same physician following an initial procedure during the
postoperative period) append modifier 79 and submit the claim.
A new postoperative period begins with the subsequent procedure.
Modifier 54 and 55
When two different physicians perform surgery and post-operative
care (Transfer of care with mutual agreement), these two modifiers play a major
role to distinguish the services.
1. Surgical
care only – Append modifier 54
2. Postoperative
care only – Append modifier 55
The physician
should use the same CPT code for global surgery service billed with modifier 54
or 55.
CMS FAQ:
Is the global surgery payment restricted to hospital inpatient
settings?
Global surgery applies in any setting, including an inpatient
hospital, outpatient hospital, Ambulatory Surgical Center (ASC), and
physician’s office. When a surgeon visits a patient in an intensive care or
critical care unit, Medicare includes these visits in the global surgical
package.