Determining the Duration of a Global Period
To determine the global period for major surgeries, count one day immediately before the day of surgery, the day of surgery and the 90 days immediately following the day of surgery.
Example:
Date of surgery – January 5.
Preoperative period – January 4.
Last day of postoperative period – April 5.
To determine the global period for minor procedures, count the day of surgery and the appropriate number of days immediately following the date of surgery.
Example:
Procedure with 10 follow-up days:
o Date of surgery – January 5.
o Last day of postoperative period – January 15.
Billing Guidelines
The following table outlines the services included in the global surgical package:
Preoperative Visits
Preoperative visits begin with the day before the surgery for major procedures and the day of the surgery for minor procedures. The global package of care includes all visits related to the surgery, in or out of the hospital, on the day of the surgery.
Intraoperative Services
These are services that are normally a usual and necessary part of the surgical procedure.
Complications Following Services
These include all additional medical or surgical services required of the surgeon during the postoperative period of the surgery due to complications that do not require additional trips to the operating room.
Postoperative Visits
These are follow-up visits during the postoperative period of the surgery that are related to recovery from the surgery.
Postsurgical Pain Management by the Surgeon
Miscellaneous Services
These services include items such as dressing changes, local incision care and removal of operative pack. Removal of cutaneous sutures, 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.
Supplies : Except for those identified as exclusions.
Definition of a Global Surgical Package
Field 16 of the Medicare Fee Schedule Data Base (MFSDB) provides the postoperative periods that apply to each surgical procedure. The payment rules for surgical procedures apply to codes with entries of 000, 010, 090, and, sometimes, YYY.
Codes with “090” in Field 16 are major surgeries. Codes with “000” or “010” are either minor surgical procedures or endoscopies.
Codes with “YYY” are carrier-priced codes, for which carriers determine the global period (the global period for these codes will be 0, 10, or 90 days). Note that not all carrier-priced codes have a “YYY” global surgical indicator; sometimes the global period is specified.
While codes with “ZZZ” are surgical codes, they are add-on codes that are always billed with another service. There is no postoperative work included in the fee schedule payment for the “ZZZ” codes. Payment is made for both the primary and the add-on codes, and the global period assigned is applied to the primary code.
Surgeons and Global Surgery
A national definition of a global surgical package has been established to ensure that payment is made consistently for the same services across all carrier jurisdictions, thus preventing Medicare payments for services that are more or less comprehensive than intended. The national global surgery policy became effective for surgeries performed on and after January 1, 1992.
The instructions that follow describe the components of a global surgical package and payment rules for minor surgeries, endoscopies and global surgical packages that are split between two or more physicians. In addition, billing, mandatory edits, claims review, adjudication, and postpayment instructions are included.
In addition to the global policy, uniform payment policies and claims processing requirements have been established for other surgical issues, including bilateral and multiple surgeries, co-surgeons, and team surgeries.
Minor Surgeries and Endoscopies during global surgery period - would get paid?
Visits by the same physician on the same day as a minor surgery or endoscopy are included in the payment for the procedure, unless a significant, separately identifiable service is also performed. For example, a visit on the same day could be properly billed in addition to suturing a scalp wound if a full neurological examination is made for a patient with head trauma. Billing for a visit would not be appropriate if the physician only identified the need for sutures and confirmed allergy and immunization status.
A postoperative period of 10 days applies to some minor surgeries. The postoperative period for these procedures is indicated in Field 16 of the MFSDB. If the Field 16 entry is 010, carriers do not allow separate payment for postoperative 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 not included in the global fee for a minor procedures except as otherwise excluded. If the Field 16 entry is 000, postoperative visits beyond the day of the procedure are not included in the payment amount for the surgery. Separate payment is made in this instance.
A. Procedure Codes and Modifiers
Use of the modifiers in this section apply to both major procedures with a 90-day postoperative period and minor procedures with a 10-day postoperative period (and/or a zero day postoperative period in the case of modifiers “-22” and “-25”).
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