Coding Questions: Global Periods

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CODING QUESTION:

What are the Global Surgical Package requirements?

ANSWER:

The global surgical package, also called global surgery, includes all the necessary services normally furnished by a surgeon before, during, and after a procedure. They fall under 3 time periods: 0 days, 10 days, or 90 days. The length of time depends on the procedure. Zero-day procedures include endoscopies and other minor procedures for which a visit on the same day is not payable. Ten-day procedures are for the day of and the following 10 days. Ninety-day procedures are major and are really 92 days, because they include the day before and the day of the service in addition to the following 90 days.

Physicians in the same group practice who are in the same specialty must bill and be paid as though they are a single physician.

Services not included as part of the global period are billed with modifiers to indicate the reasons. Modifiers added to the E/M codes include 25, 57 & 24. The use of 25 or 57 on the E/M of the initial visit indicates when the decision for surgery was made. The only difference is whether it’s a minor procedure [25] or a major [57]. Modifier 24 is used for visits unrelated to the surgical procedure.

Other modifiers are added to procedure codes. Modifiers 54 and 55 are used when the care is transferred between providers. Modifier 58 is added to the code of the second part of a staged procedure or a more extensive service if the original procedure failed. Modifier 78 is added when an unplanned return to the OR is required, and Modifier 79 indicates a return to the OR for an unrelated service.

The CPT 99024 is used instead of 99212-99215 when there is a follow-up visit within the global period with no adverse effects or complications.

Understanding the basics of the global surgical package and using appropriate modifiers can help improve your billing process and reimbursement.

Still have questions? Our team can help. Please contact Lsummy@medicmgmt.com for one-on-one support.

Laura Summy is Managing of coding of MMG Healthcare Solutions / Medic Management Group. MMG is a national provider of consulting services and back office administrative support to independent and system owned physician practice groups.  Additionally, MMG has been formally recognized as a multi-year Northeast Ohio Top Workplaces award winner.

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