Medical Billing Services

Billing Guidelines for Global Surgery Modifiers

The global surgical package, also called global surgery, includes all the necessary services normally furnished by a surgeon before, during, and after a procedure. Medicare payment for a surgical procedure includes the pre-operative, intra-operative, and post-operative services routinely performed by the surgeon or by members of the same group with the same specialty. Physicians in the same group practice who are in the same specialty must bill and be paid as though they were a single physician. Use following billing guidelines for global surgery modifiers, as these modifiers are used by physicians to indicate a billed service is not part of a global surgical package and is eligible for separate reimbursement. 

Use Following Billing Guidelines for Global Surgery Modifiers

Modifier ‘-24’

Unrelated E/M service by the same physician during a postoperative period. The physician may need to indicate that an E/M service was furnished during the post-operative period of an unrelated procedure. An E/M service billed with modifier ‘-24’ must be accompanied by documentation that supports that the service is not related to the post-operative care of the procedure. In order for the evaluation and management service to be payable in the post-operative period with the modifier ‘-24’, the diagnosis code supporting the E/M service must be different from the diagnosis code reported for the previously performed surgery.

Modifier ‘-25’

Significant, separately identifiable evaluation and management service by the same physician on the day of a procedure or other service. 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 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.

Modifier ‘-57’

An evaluation and management service that resulted in the initial decision to perform the surgery may be identified by adding modifier 57 to the appropriate level of E/M service. E/M services on the day before or on the day of major surgery (90-day global period) which result in the initial decision to perform the surgery are not included in the global surgery payment. These E/M services may be billed separately and identified with the modifier 57.

This modifier should not be used for visits furnished during the global period of minor procedures (0- or 10-day global period) unless the purpose of the visit is a decision for major surgery. This modifier is not used with minor surgeries because the global period for minor surgeries does not include the day prior to the surgery. When the decision to perform the minor procedure is typically done immediately before the service, it is considered a routine preoperative service, and a visit or consultation is not billed in addition to the procedure.

Modifier ‘-58’

A staged or related procedure or service by the same physician during the post-operative period was established to facilitate billing of staged or related surgical procedures done during the post-operative period of the first procedure. Modifier ‘-58’ may be reported with the staged procedure’s CPT. A new postoperative period begins when the next procedure in the series is billed. Modifier ‘-58’ indicates that the performance of a procedure or service during the postoperative period was: 

  • Planned prospectively or at the time of the original procedure
  • More extensive than the original procedure 
  • For therapy following a diagnostic surgical procedure

Modifier ‘-59’

Distinct Procedural Service. Under certain circumstances, it may be necessary to indicate that a procedure or service was distinct or independent from other non-E/M services performed on the same day. Modifier 59 is used to identify procedures or services, other than E/M services, that are not normally reported together but are appropriate under the circumstances. Documentation must support a different session, different procedure or surgery, different site or organ system, separate incision or excision, separate lesion, or separate injury (or area in injury in extensive injuries) not ordinarily encountered or performed on the same day by the same individual. However, when another already established modifier is appropriate it should be used rather than modifier 59. Modifier 59 should only be used if there is no other more descriptive modifier available and the use of modifier 59 best explains the circumstances. Modifier 59 should not be appended to an E/M service.

Modifier ‘-78’

In addition to the CPT code, physicians report modifier ‘-78’ (Unplanned return to the operating or procedure room by the same physician following initial procedure for a related procedure during the postoperative period). The physician may also need to indicate that another procedure was performed during the post-operative period of the initial procedure. When this subsequent procedure is related to the first procedure and requires the use of the operating room, this circumstance may be reported by adding the modifier ‘-78’ to the related procedure. The CPT definition for modifier ‘-78’ does not limit its use to treatment for complications.

Modifier ‘-79’ 

Unrelated procedure or service by the same physician during a postoperative period. The physician may need to indicate that a procedure or service furnished during a postoperative period was unrelated to the original procedure. A new postoperative period begins when the unrelated procedure is billed.

We hope billing guidelines shared in this Blog for global surgery modifiers 24,25,57,58,59,78, and 79 would be useful for accurate surgery coding and billing. If you are looking for any assistance in surgery coding and billing, contact us at info@medicalbillersandcoders.com/ 888-357-3226

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