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GLOBAL SURGERY GUIDELINES

CMS published Global Surgery Booklet. It contains frequently asked questions, global coding and billing guidelines, specifics of billing in operative period and special situations. A very useful document is a must-read for physicians, who conducts surgeries, even minor. As usually WCH saves your time and provides an abstract of the booklet with essential points

What is global surgical package? 

The global surgical package, also called global surgery, includes all the necessary services before, during, and after a procedure normally furnished by a surgeon or by members of the same group. Physicians in the same group practice who are in the same specialty must bill and be paid as though they were a single physician.

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Types of surgical packages. 

0-day post-operative period (endoscopy and minor procedures 

No pre-operative period, no post-operative days, visit on day of the procedure is generally not payable, unless you conducted and documented it as a separate service.

10-day post-operative period (other minor procedures) 

No pre-operative period, visit on day of the procedure is generally not payable, unless you conducted and documented it as a separate service. Total global period is 11 days, starting on day of the procedure.  

90-day post-operative period (major procedures) 

Total global period is 92 days, starting on day before the procedure, visit on day of the procedure is generally not payable, unless you conducted and documented it as a separate service. 

How to check it? 

Online Look-up tool provides you with detailed information on each procedure code, including global surgery indicator. There is a Help document on the page to determine which column gives you the answer. To check global surgery indicator you need to find the column named “GLOBAL”- it will show 000, 010 or 090.  Just don’t forget to choose type of info: “All”.  There also can be indicator “YYY” which means that your MAC determines the global period for this procedure.

Remember! This is included in surgical package:

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.

Decision for surgery. 

Initial consultation or evaluation of the problem to determine if the surgery is needed is billed separately with modifier 57. This applies for major procedures only. 

Split global-care with 54 and 55 modifiers 

More than one physician may furnish services included in the global surgical package. It is possible that the physician who performs the surgical procedure does not furnish the follow-up care. When physicians agree on the transfer of care during the global period, the appropriate modifier should be applied: 

  • Surgical care only – modifier 54
  • Post-operative management only – modifier 55 

The same procedure code must be billed along with suitable modifier. The date of service is the date the surgical procedure was furnished.

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Modifiers 24, 25 and 79 

If patient’s condition requires additional separate E&M service by the same physician on the same day of the procedure, a modifier 25 need to be applied. If this visit falls within the post-operative period, then both 24 and 25 modifiers must be applied. 

Different diagnoses are not required, both services must be properly documented to prove medical necessity. 

Modifier 79 must be used when physician made a procedure or service, unrelated to the original procedure during post-operative period. A new post-operative period begins when the unrelated procedure is billed.

Co-Surgeons and Team Surgeons 

There could be a situation where two or more surgeons are required to perform surgery on the same patient during the same operative session. These additional physicians are not acting as assistants-at-surgery. 

In case of two surgeons, claims from both of them must contain 62 modifier for the procedure. 

In case of a surgical team, claims from each of them must contain 66 modifier for the procedure.

 

Special Reporting for Certain Practitioners for CPT code 99024 

Practitioners are required to report post-operative E/M visits using CPT code 99024 if they:

  • Practice in one of the following nine states: Florida, Kentucky, Louisiana, Nevada, New Jersey, North Dakota, Ohio, Oregon, or Rhode Island; and 
  • Practice in a group of ten or more practitioners; 
  • Practitioners who only practice in practices with fewer than 10 practitioners are exempted from required reporting, but are encouraged to report if feasible and, 
  • Provide global services under one of the required procedure codes. The required procedure codes are those that are furnished by more than 100 practitioners and either are nationally furnished more than 10,000 times annually or have more than $10 million in annual allowed charges. 

Subsequent procedure. Modifiers 58 and 78 

A new post-operative period begins with the subsequent procedure. This includes procedures done in 2 or more parts for which the decision to stage was taken ahead or at the time of the first procedure.

Staged procedure requires usage of 58 modifier on claim. A new post-operative period begins when the next procedure in the series is billed.

Treatment of complications or another unplanned return to the operating room requires to report the CPT code that describes the procedure, performed during the return trip. Original surgery code must not be reported, unless the same procedure was repeated. In addition it is required to use modifier 78 on the claim.

Full document and additional resources are available here.   

HIPAA
Insights
September 2018