Return To The Or For A Related Procedure During The Post
When treatment for complications requires a return trip to the OR, physicians bill the CPT code that describes the procedure performed during the return trip. If no such code exists, use the unspecified procedure code in the correct series, i.e., CPT code 47999 or 64999. The procedure code for the original surgery identical procedure is repeated. In addition to the CPT code, physicians report modifier -78 .
The physician may also need to indicate that another procedure was performed during the post-operative period of the initial procedure. When this subsequent procedure is related to the first procedure, and requires the use of the operating room, this circumstance may be reported by adding the modifier -78 to the related procedure.
Staged or Related Procedure or Service by the Same Physician During the Post-operative Period
Modifier -58 was established to facilitate billing of staged or related surgical procedures done during the post-operative period of the first procedure. Modifier -58 indicates that the performance of a procedure or service during the post-operative period was:
- Planned prospectively or at the time of the original procedure
- More extensive than the original procedure or
- For therapy following a diagnostic surgical procedure.
Modifier -58 may be reported with the staged procedures CPT code. A new post-operative period begins when the next procedure in the series is billed.
In addition to the CPT code, physicians report modifier -78 .
Physicians Who Furnish The Entire Global Package
Physicians who furnish the surgery and furnish all of the usual pre-and post-operative work may bill for the global package by entering the appropriate CPT code for the surgical procedure only. Separate billing is not allowed for visits or other services that are included in the global package.
When different physicians in a group practice participate in the care of the patient, the group practice bills for the entire global package if the physicians reassign benefits to the group. The physician who performs the surgery is reported as the performing physician.
What Does Incidental Mean In Medical Billing
An incidental procedure is carried out at the same time as a more complex primary procedure. These procedures require little additional provider resources and are generally not considered necessary to the performance of the primary procedure. An incidental procedure is not reimbursed separately on a claim.
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Global Period Services And Package Information
Services included in Global Period Package
Services not included in Global Period Package
How Are Minor Procedures And Endoscopies Handled
Minor procedures and endoscopies have post-operative periods of 10 days or zero days . For 10-day post-operative period procedures, Medicare does not allow separate payment for post-operative visits or services within 10 days of the surgery that are related to recovery from the procedure. If a diagnostic biopsy with a 10-day global period precedes a major surgery on the same day or in the 10-day period, the major surgery is payable separately. Services by other physicians are generally not included in the global fee for minor procedures.
For zero day post-operative period procedures, operative visits beyond the day of the procedure are not included in the payment amount for the surgery. Post- procedure is payable separately.
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E/m Service: Global Surgery Denials Co 97
Denial Reason, Reason/Remark CodeResources Additional Modifiers May ApplyWas the E/M service performed by the same physician on the same day as a minor surgical procedure? Adjudication of Claims for Global SurgeriesA.Fragmented Billing of Services Included in the Global PackageB.Claims From Physicians Who Furnish Less Than the Global Package EXAMPLEC.Payment for Return Trips to the Operating Room for Treatment of Complications
Billing The Global Surgical Package
Medicare, Medicaid, and third-party commercial insurers employ the concept of a global surgical package when reimbursing surgeons for specific medically necessary services that they provide to patients under their care. What this means is that certain services are incidental to the main procedure, or that they are considered an integral component of that surgical procedure. This includes both evaluation and management services, as well as physical interventions that may be required in order for the procedure to be successful.
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What Services Are Not Included In The Global Surgery Payment
- Treatment for post-operative complications requiring a return trip to the Operating Room . An OR, for this purpose, is defined as a place of service specifically equipped and staffed for the sole purpose of performing procedures. The term includes a cardiac catheterization suite, a laser suite, and an endoscopy suite. It does not include a patients room, a minor treatment room, a recovery room, or an intensive care unit
- If a less extensive procedure fails, and a more extensive procedure is required, the second procedure is payable separately
- Immunosuppressive therapy for organ transplants
- Critical care services codes 99291 and 99292) unrelated to the surgery where a seriously injured or burned patient is critically ill and requires constant attendance of the physician.
The Global Surgical Package
Consistent with this, all intra-operative services that the surgeon performs are considered a necessarily important part of the surgical procedure. Evaluation performed in the operating suite is not coded or billed separately. The HCPCS code for the procedure includes everything that happens while the procedure is being performed.
After the surgical procedure is concluded, any services that a surgeon provides to deal with anticipated or unanticipated complications relating to the surgery are considered part of the global surgical package. For major operations, this means that complications that occur within ninety days after the procedure was completed are bundled into the initially reported code. For minor operations, complications that occur within ten days after the surgery are considered integral with dealing with the patients immediate care. For the least invasive operations, such as endoscopies, in which the incidence of complication are very low, and that carry a global period of zero, next day complications can be coded and billed for appropriate reimbursement. These guidelines include all post-operative visits related to the surgery, as well as post-surgical pain management.
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What Is Global In Medical Billing
global medical billing
A global period is a period of time starting with a surgical procedure and ending some period of time after the procedure. These components of the surgical package are not eligible for separate reimbursement and will be denied if billed within the global period of the associated procedure.
Subsequently, question is, what CPT codes have a global period? The global period for these codes will be 0, 10, or 90 days. Note: not all contractor-priced codes have a YYYglobal surgical indicator. Sometimes the global period is specified as 000, 010, or 090. While codes with ZZZ are surgical codes, they are add-on codes that you must bill with another service.
Secondly, what does it mean to Bill globally?
Global billing is designed to eliminate some of the headache of having a major procedure performed. Instead of receiving separate bills from your doctor, the hospital facility, the technicians that assisted your doctor, and again from the hospital for the equipment used during your procedure you get one giant bill.
What is the global surgical package?
The global surgical package is a single payment for all care associated with a surgical procedure. The payment is based on three phases of a surgical procedure. This definition outlines what is considered incidental or included in the surgical package but doesn’t go into great detail.
Defining The Postoperative Period For Billing Purposes
There are three types of global surgical packages with a different number of postoperative days included in each.
0-Day postoperative period
10-Day postoperative period . There is no preoperative period and includes services provided on the surgical day and 10 days following the day of surgery.
90-Day postoperative period . A 1-day preoperative period is included, along with the day of surgery and then 90 days following the surgery.
A complete listing of postoperative periods for surgical procedures can be found in the Medicare Physician Fee Schedule .
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Global Surgical Package : Included Services
The following services are included in the SGP payment and cannot be billed for separately:
-
Follow-up visits during the postoperative period of the surgery that are related to routine recovery from the surgery.
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Postoperative pain.
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Supplies, except for those identified by the surgeon .
-
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 insertion, irrigation and removal of urinary catheters, routine peripheral intravenous lines, nasogastric and rectal tubes and changes and removal of tracheostomy tubes. VAC changes would be included if the patient is in the 10-day or 90-day global period.
Follow-up in office care, including treatment of complications not requiring a return to the operating room, is included in postoperative surgical package. Also, typical in-hospital follow-up care is included in the postoperative surgical package. If critical care services are being rendered, it is logical to appropriately and legitimately bill for them, as payments will be higher.
Whats An Incidental Benefit
Incidental benefit means anything valued in excess of $100 provided by the developer that is acquired by a purchaser upon acquisition of a time-share and includes without limitation exchange rights, travel insurance, bonus weeks, upgrade entitlements, travel coupons, referral awards, and golf and tennis packages.
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What Does Global Mean In Medical Billing
The global charge refers to both components when billed together. For services furnished to hospital outpatients or inpatients, the physician may bill only for the professional component, because the statute requires that payment for nonphysician services provided to hospital patients be paid only to the hospital.
Global Surgical Package Period1
Surgical procedures, categorized as major or minor surgery, are reimbursed for pre-, intra-, and postoperative care. Postoperative care varies according to the procedures assigned global period, which designates zero, 10, or 90 postoperative days.
Services classified with XXX do not have the global period concept. ZZZ services denote an add-on procedure code that must always be reported with a primary procedure code and assumes the global period assigned to the primary procedure performed.
Major surgery allocates a 90-day global period in which the surgeon is responsible for all related surgical care one day before surgery through 90 postoperative days with no additional charge. Minor surgery, including endoscopy, appoints a zero-day or 10-day postoperative period. The zero-day global period encompasses only services provided on the surgical day, whereas 10-day global periods include services on the surgical day through 10 postoperative days.
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How Is Global Surgery Classified
There are three types of global surgical packages based on the number of post-operative days.
Zero Day Post-operative Period
- No pre-operative period No post-operative days
- Visit on day of procedure is generally not payable as a separate service
Ten-day Post-operative Period,
- No pre-operative period
- Visit on day of the procedure is generally not payable as a separate service
- Total global period is 11 days. Count the day of the surgery and 10 days following the day of the surgery
Ninety-day Post-operative Period
- One day pre-operative included
- Day of the procedure is generally not payable as a separate service
- Total global period is 92 days. Count 1 day before the day of the surgery, the day of surgery, and the 90 days immediately following the day of surgery
Everything You Ever Wanted To Know About The Global Surgical Package: Coding And Billing For The Gsp
If you do the professional fee coding or billing for surgeries, you know that the rules surrounding the Global Surgical Package are many and can be complex. CMS just published a new fact sheet on the GSP and its a great recap for coders and billers.
The global surgical package, also called global surgery, includes all necessary services normally furnished by a surgeon before, during, and after a procedure. Medicare payment for the 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.
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Ignoring The Global Period For Minor Surgical Procedures
Everyone remembers post-op visits after a major surgical procedure are not separately billable. Everyone remembers that a procedure that occurs in the post-op period after a major surgical procedure will need a modifier.
But we forget about these things for minor procedures. Minor procedures have either 0 or 10-day global days assigned to them.
If a procedure has 10 global days that means that related follow-up is not separately reported for ten days after the procedure.
That is, when the patient returns to have their stitches removed or for a post-op check, the correct code is 99024, which has no RVUs or payment associated with it.
That is, we dont charge for the post-op visit. But what if the patient returns within the global period?
For example, a patient has an I& D of an abscess on June 1, and returns on June 5 because of worsening symptoms. The physician does a second I& D on that day. This second procedure is related to the first procedure and occurs during the global period. The E/M service is not separately billable, but the procedure is. The practice must append modifier 58 to that stage or related procedure. Otherwise, the practice does not get paid.
Similarly, perhaps the patient returns on June 5 for a cough. This cough is unrelated to the I& D of the abscess done on June 1st. The practice reports the E/M service with modifier 24. And of course, the diagnosis code must be the cough or final diagnosis related to the cough.