Global surgery billing with correct and incorrect billing example

GLOBAL SURGERY

Definition

Global surgery is combining reimbursement for the surgical procedure and certain costs associated with the surgical procedure into one fee.

Physician Payment Reform (PPR) established a national definition of a “global surgery package” so that each Medicare carrier’s payment for the same services was consistent.

A global package of care consists of all necessary services performed by the physician before, during and after a surgical procedure. Medicare payment includes all applicable preoperative and intraoperative services, complications from the surgery and postoperative care.

The Medicare-approved amount for these procedures includes payment for the services listed later as related to the surgery when furnished by the physician who performs the surgery.

The services included in the global surgical package may be furnished in any setting, such as hospitals, Ambulatory Surgical Centers (ASCs) and physicians’ offices. Visits to a patient in an intensive care or critical care unit are also included if made by the surgeon. However, critical care services (99291–99292) are payable separately in some situations (e.g., a seriously injured or burned patient is critically ill and requires constant attendance by the physician).

Any procedure code listed in the surgical section of the physician’s Current Procedural Terminology (CPT) book in the range of 10021–69990, and any national or local Healthcare Common Procedure Coding System (HCPCS) codes defined as surgical procedures, are subject to the global surgical provision as either major or minor surgeries.

Example of Correct Billing

Dr. A performed a major surgery today and submitted a claim to Medicare. Next week, the patient will return for a postoperative visit and have a surgical dressing change; Dr. A charges nothing on this day.

Example of Incorrect Billing

Dr. B performed a major surgery today. The patient will come in the office three times next week for postoperative evaluations; Dr. B bills for the surgery and three office visits.