(2022) How To Use Global Period In Medical Billing

A global period is the time frame for routine after surgery. Below we explain what a global period is, what global period status indicators are, how to calculate a global period, and services that are included and not included in a global period.

1. What Is Global Period?

The global period indicates a time frame for routine care by the physician after surgery. For example, the necessary services that the physician furnishes. This can be;

• postoperative;
• intraoperative; or
• preoperative.

Reimbursement of the surgery is included and can not be reported separately.

2. Global Period Status Indicators

Every CPT code has a global period status indicator. Minor or endoscopies or procedures are only reimbursable on the day of service. E/M services on the date of the procedure are not payable. Examples are CPT 31622, CPT 43235, and CPT 45378.

Minor procedures that include preoperative relative values on the procedure date and a postoperative period of ten days can be reimbursed. 

However, it is impossible to reimburse E/M service on the day of the procedure and a 10-day postoperative period. Examples are CPT 46221, CPT 11401, and CPT 10060.

Major one-day preoperative period procedures with a postoperative period of ninety days are a component of the global package. 

Therefore, E/M services provided the day before the procedure or during the ninety-day postoperative period can not be reimbursed.

The normal global period does not apply to maternity codes. Examples are CPT 59620 and CPT 59610.

The global concept does not apply to most E/M services, radiology, laboratory, or anesthesia services.

Unlisted codes are subject to individual pricing. Examples are CPT 42999, CPT 32999, and CPT 29999.

Add-on codes are related to another procedure code and are included in the global period of the primary procedure. Examples are CPT 26125 and CPT 17003.

3. How To Calculate Global Period

The global period can be calculated with the status indicator of a CPT code. For example, a code from a minor surgery includes a status indicator of ten days, and a major surgery with a status indicator of ninety days.

3.1 Minor Surgery

You can determine the global period for a minor surgery by counting the days of the surgery (this includes any intra- or preoperative services) and the ten days that follow the surgery.

3.1 Major Surgery

You can determine the global period for a major surgery by counting one day before the surgery date, adding this up with the day of surgery and ninety days that follow the surgery.

You can find a global period calculator here. 

4. Services That Include A Global Period

Medicare has approved the following services. Services that include a global period are described below.

4. 1 Preoperative Visits

Services that describe a preoperative visit if a decision is made to operate on the day before for major surgeries and the day of surgery for minor surgeries. These procedures are included in the global period.

4.2 Intra Operative Services

Intraoperative procedures are normal and necessary to provide the surgery.

4.3 Complications/Postoperative Visits

This is also called aftercare. This can be any service provided for additional medical or surgical care during a postoperative period. Complications are included but only if no extra trips to the operating room are needed.

5. Services That Do Not Include Global Period

Make sure to add the correct modifier for reimbursement purposes. The following services are not included during the global period.

5.1 Initial Consultation

A surgeon uses an initial consultation/evaluation to see if the surgery is needed. This service is not included in the global period.

Use modifier 25 to show that the surgeon provided the service to determine the need for the surgery.

5.2 Visits Unrelated To The Surgery

Sometimes a patient has a condition that this unrelated to the surgery. A global period is not included when a physician meets the patient for an unrelated condition.

You need to report modifier 24 with the E/M service to show that the service was unrelated to the surgery and performed during a postoperative period. Do this for minor and major procedures.

5.3 Diagnostic Procedures Or Tests

Any diagnostic radiological procedures are included that are provided during the postoperative period.

You do not need to add any modifiers besides informational modifiers like modifier LT or modifier RT.

5.4 Distinct Surgical Procedures

Distinct surgical procedures are used for surgical services for different diagnoses in the postoperative period. These procedures are not repeated operations to treat a complication.

Report modifier 79 to show that this is a newly performed surgery. Therefore, the postoperative period starts with the subsequent procedure.

5.5 Postoperative Complication Treatments

Treatment for postoperative complications requires an extra visit to the operation room. Report modifier 78 in this case.

6. Resources

https://www.cms.hhs.gov/Transmittals/downloads/R954CP.pdf

https://www.periodprohelp.com/what-does-global-period-mean-in-medical-billing/

https://www.medicalbillingcodings.org/2011/04/global-period.html