What services are
included in the global surgery payment?
When the physician who furnishes the surgery also furnishes the following
services, Medicare includes them in the global surgery payment:
•Pre-operative visits after the decision is made to operate. For major
procedures, this includes pre-
operative visits the day before the day of surgery. For minor procedures, this
includes pre-operative
visits the day of surgery;
•Intra-operative services that are normally a usual and necessary part of a surgical
procedure;
• 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;
• Follow-up visits during the post-operative period of the surgery that are
related to recovery from the surgery;
• Post-surgical pain management by the surgeon;
• Supplies, except for those identified as exclusions: and
• 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.
What services are not included in the global surgery payment?
The following services are not included in the global surgical payment. These
services may be billed and paid for separately:
• Initial consultation or evaluation of the problem by the surgeon to determine
the need for major surgeries. This is billed separately using the modifier -57 (Decision for
Surgery). This visit may be billed separately only for major surgical
procedures:
Note: The initial evaluation for minor surgical procedures and endoscopies is
always included in the global surgery package. Visits by the same physician on the same day as
a minor surgery or endoscopy are included in the global package, unless a significant, separately
identifiable service is also performed. Modifier -25 is used to bill a separately identifiable
evaluation and management (E/M) service by the same physician on the same day of the procedure.
• Services of other physicians related to the surgery, except where the surgeon
and the other physician(s) agree on the transfer of care. This agreement may be
in the form of a letter or an annotation in the discharge summary, hospital
record, or ASC record;
• Visits unrelated to the diagnosis for which the surgical procedure is performed,
unless the visits occur due to complications of the surgery;
• Treatment for the underlying condition or an added course of treatment which
is not part of normal recovery from surgery;
• Diagnostic tests and procedures, including diagnostic radiological
procedures;
• Clearly distinct surgical procedures that occur during the post-operative
period which are not re-operations or treatment for complications;
