Global Period is a time frame following surgery during which routine care by the physician i.e., all necessary services normally furnished by a physician [before (Pre-operative), during (Intra-Operative), and after (Post-operative) the procedure] are included in the reimbursement of the original surgery and they cannot be separately reported.
List Of Global Period Status Indicators
Each CPT has a Global period status indicator as per the CMS Payment Policies.
000 Endoscopies or minor procedure with preoperative and postoperative relative values on the day of the procedure only are reimbursable.
010 Minor procedures with preoperative relative values on the day of the procedure and postoperative relative values during a 10-day postoperative period are reimbursable services.
Evaluation and Management services on the day of the procedure and during the 10-day postoperative period are not reimbursable. (For example: CPT 10060, 11401, 46221)
090 Major procedures with one day preoperative period and 90-days postoperative period are considered to be a component of global package of the major procedure.
Evaluation and Management services on the day prior to the procedure, the day of the procedure, and during the 90-day postoperative period are not reimbursable. (For example: CPT 32100, 39000, 41520)
MMM Maternity codes; the usual global period concept does not apply. (For example: CPT 59610, 59620)
XXX The global concept does not apply to this code. (For example: Evaluation and Management services, Anesthesia, Laboratory and Radiology procedures)
YYY These are unlisted codes, and subject to individual pricing. (For example: CPT 29999, 32999. 42999)
ZZZ These represent add-on codes. They are related to another service and are always included in the global period of the primary service. (For example: 17003, 26125)
The Global period status indicators and the CPT’s Relative Value Units are available in the path http://www.cms.hhs.gov/pfslookup/02_PFSsearch.asp. (Click the link and select Payment policies indicator under Type of information to view the Global period of each CPT)
Calculating The Duration Of A Global Period
Each surgery CPT has a Global surgery status indicator in which the minor surgery has Global surgery status indicator of 10 days and the major surgery has Global surgery status indicator of 90 days.
To determine the global period for minor surgeries:
Count the day of surgery (Pre-operative and Intra-operative services would be on the same day of surgery) and 10 days immediately following the date of surgery.
To determine the global period for major surgeries:
Count 1 day immediately before the day of surgery (Pre-operative), the day of surgery (Intra-operative), and the 90 days immediately following the date of surgery (Post-operative / follow ups)
Global period calculator for the major surgery is available at: http://www.medicarenhic.com/providers/billing/billing_calc_global_period.html
Services Included In The Global Period
Medicare approved amount (based on the Resource Based Relative Value Scale) for the surgery (minor / major) includes following services when furnished by the physician who actually performs the surgery.
The services included in the global surgical package may be furnished in any setting, i.e., in hospitals, ASC’s, physicians offices and such services / procedures / supplies related to the original surgery are not to be reported separately in the claim form since these are considered as a component of the approved amount.
The Following Services Are Included In The Global Package
Pre-operative visits: Pre-operative visits after the decision is made to operate beginning with the day before the day of surgery for major procedures and the day of surgery for minor procedures
Intra-operative services: lntra-operative services that are normally a usual and necessary part of a surgical procedure.
Complications following surgery / Post-Operative visits: Refers to ‘Aftercare’ following the surgery i.e. all routine additional medical or surgical services required of the surgeon during the post-operative period of the surgery.
These services include complications that do not require additional trips to the operating room.
Along with all of the above global package of a surgery includes Items such as dressing changes; local incisional care that includes removal of operative pack and dressing change, cutaneous sutures and staples (removals), lines, wires, tubes, drains, casts and splints, insertion, irrigation and removal of urinary catheters, routine peripheral intravenous lines, nasogastric and rectal tubes, changes and removal of tracheostomy tubes.
Services Not Included In The Global Period
In certain circumstances some of the services / procedures are also paid if performed in the Global period.
Appending correct modifier is mandatory for reimbursement. The services / procedures that are not included and are reimbursable during the Global period are as follows.
The initial consultation or evaluation of the problem by the surgeon to determine the need for surgery. The correct modifier is to be appended in case of minor and major surgery for a proper reimbursement.
Minor Surgery with 10 day Global period – Modifier 25 (Significant, separately identifiable E & M service by same Physician on same day of procedure or other service) should be applied for an Evaluation and Management services rendered on the same day of surgery.
For example: If a patient is encountered for a follow up office for his neck pain and in addition if the patients needs his / her leg abscess to be drained and if the physician does both on the same day then the claim would be billed as:
Since CPT 10060 has a global period of 10 days the services and the procedures performed including dressing change during this period would be considered as a part of global component and no separate reimbursement are made.
Major Surgery with 90 days global period – Modifier 57 (Decision for surgery) has to be applied for an Evaluation and Management services to report that the decision for major surgery was made during the service either the day before the surgery or the day of surgery.
Visits Unrelated To The Original Surgery
If the physician encounters a patient for a different condition that was not related to the surgery.
Modifier 24 should be applied for an E & M services to state that the service performed during a postoperative period for reason(s) unrelated to the original procedure. This applies for both minor and major procedures.
Diagnostic Tests And Procedures
This includes diagnostic radiological procedures performed in the post operative period to the operated site.
No modifiers other than the informational modifiers (modifiers like RT / LT) are needed.
Distinct Surgical Procedures
This includes for distinct surgical procedures for a different diagnosis during the post-operative period which are not repeat operations or treatment for complications. A new post-operative period begins with the subsequent procedure.
Modifier 79 (Unrelated procedure or service by same physician during postoperative period) should be applied to the newly performed surgery.
Treatment For Post-Operative Complications
Treatment require a return visit to the operating room. In such case Modifier 78 (Return to the operating room for related procedure during postoperative period) should be added for the procedure performed during the return visit.
Please have a look into Medicare Claim Processing for the payment of Evaluation and Management services provided during Global period of surgery.