Healthcare Fraud Shield’s Latest Article: Unwrapping the Global Surgery Mystery

3 May

So many questions to answer, What is the Global Surgery Package? What services are included in it? What services can be billed separately during the global days? Let’s break it down.


According to the Centers for Medicare & Medicaid (CMS), Medicare established a national definition of a global surgical package to ensure that Medicare Administrative Contractors (MACs) make payments for the same services consistently across all jurisdictions. The global surgical package, also called global surgery, includes all the necessary services normally furnished by a surgeon before, during, and after a procedure. Medicare payment for a surgical procedure includes the pre-operative, intra-operative, and post-operative services routinely performed by the surgeon or by members of the same group with the same specialty. Physicians in the same group practice who are in the same specialty must bill and be paid as though they were a single physician.[i]


What is included (bundled in) the Global Surgical Package?

  • Pre-operative visits after the decision have been made to operate. 
  • For minor procedures, this includes pre-operative visits the day of surgery; and,
  • For major procedures, this includes pre-operative visits the day before the day of surgery.
  • Local infiltration, metacarpal, metatarsal, digital blocks, or topical anesthesia;
  • Immediate postoperative care, including dictating operative notes, talking with the family and other physicians or other qualified health care professionals;
  • Writing orders;
  • Evaluating the patient in the post-anesthesia recovery room; and,
  • Typical postoperative follow-up care:
  • All additional medical or surgical services required of the surgeon during the post-operative period of the surgery because of complications which do not require additional trips to the operating room;
  • Post-surgical pain management by the surgeon;
  • Supplies (except any identified as exclusions);
  • Miscellaneous services such as dressing changes, local incision care, removal of operative pack, removal of cutaneous sutures and staples, lines, wires, tubes, drains, casts, and splints. It includes insertions, irrigation, and removal of urinary catheters, routine peripheral intravenous lines, nasogastric and rectal tubes, and changes and removal of tracheostomy tubes.[ii]

There are three (3) distinct categories within the Global Surgery Package, based on the extent of the procedure and the recovery time:
The 0-Day Post-operative Period: This type of surgery includes minor procedures:

  • There is no pre-operative period; No post-operative period; and The day of the procedure is generally not payable as a separate Evaluation and Management (E/M) service (as the pre-operative, intra-operative and post-operative components are already included in the billed service).
  • An example would be CPT 11000 (Debridement of infected skin) has a 0 day global period.

In other words, unless there is an unrelated and/or extensive E/M service (for which append modifier 25) the ONLY billing on the DOS should be the surgical procedure.
The 10-Day Post-operative Period: These are considered minor but more involved procedures, such as complex wound repair or percutaneous vertebroplasty:

  • There is no pre-operative period; Visit on day of the procedure is generally not payable as a separate E/M service; and Total global period is 11 days (count the day of the surgery and then the 10-days immediately following the day of surgery).
  • An example would be CPT 10040 (Acne Surgery) which has a 10 day global period.

In other words, unless there is an unrelated and/or extensive E/M service (for which append modifier 25) the ONLY billing on the DOS through the next 10-days by the rendering provider should be the surgical procedure.
The 90-day Post-operative Period: These are considered major surgical procedures requiring a prolonged recovery period:

  • There is one day pre-operative E/M included; Day of the procedure is generally also not payable as a separate service; and A total global surgical period of 92-days (Count 1 day before the day of surgery, the day of surgery and the 90 days immediately following the day of surgery.
  • An example would be CPT 11450 (Removal of sweat gland lesion) which has a 90 day global period.

In other words, unless there is an unrelated and/or extensive E/M service (for which append modifier 25) there should be no E/M service billed by the surgeon from the day before the surgery to 90 days after the day of surgery.


What to look for?

  • Look for instances with excessive modifiers appended to E/Ms along with a surgery
  • Look for providers billing one day just outside the global period to bypass edits.

If you have any questions or comments, please reach out to SIU@hcfraudshield.com

REFERENCES

[i]Global Surgery Booklet (cms.gov)

[ii]Your Quick Guide to the Global Surgical Package – AAPC Knowledge Center

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