Basics of Global Period
In Orthopedic surgery, the global period can be an important consideration for the billing of services. A global period is a period of time starting with a surgical procedure and ending some period of time after the procedure. Many surgeries have a follow-up period during which charges for normal postoperative care are bundled into the global surgery fee. Reimbursement for surgical procedures includes payment for all related services and supplies that are routine and necessary to perform the procedure. These components of the surgical package are not eligible for separate reimbursement and will be denied if billed within the global period of the associated procedure.
In the Centers for Medicare & Medicaid Services’ (CMS’) Global Surgery Booklet, there are three different levels of “global surgical packages” that CMS recognizes:
- 0-day post-operative period: This is the classification for extremely minor procedures i.e., ones that have no pre-op period and are not generally billable as a separate service. The most common example would be endoscopies.
- 10-day postoperative period: This global period definition is similar to 0-day periods in those procedures that have this classification have no pre-op period and that the visit on the day of the procedure is not billable as a separate service.
- 90-day postoperative period: This is the classification for major Orthopedic surgery procedures that include pre-operative periods. Although the title says it is a 90-day period, it is technically 92 days. As the CMS booklet states: “Count 1 day before the day of the surgery, the day of surgery, and the 90 days immediately following the day of surgery.”
Excluded Services from the Global Surgical Package
Some professional services are not included in the reimbursement for a surgical procedure and therefore may be eligible for separate reimbursement. It may be necessary to append an appropriate modifier to the code for the service to identify the circumstances which make the code eligible for separate reimbursement.
These services are as follows:
- New patient E/M services
- An E&M service the day before or the day of a major surgical procedure only if the initial decision to perform the surgery was made during that visit. Modifier-57 must be attached to the E&M code to indicate a decision for surgery.
- An E&M service is provided on the same day as a minor procedure only if the E&M service is unrelated to the procedure performed. Modifier-25 must be attached to the E&M code to indicate the E&M is significant and separately identifiable.
- An E&M service during the surgical postoperative period only if the visit is unrelated to the surgical procedure. Modifier-24 must be attached to the E&M code to indicate the E&M is unrelated to the procedure performed.
- A repeat surgical procedure by the same surgeon was performed on the same day as the original surgery, requiring a return trip to the operating room. Modifier-76 must be attached to the procedure code to indicate a repeat surgical procedure. The use of modifier-76 must be substantiated by documentation.
- A repeat surgical procedure by a different surgeon, on the same day as the original surgery, requiring a return trip to the operating room. Modifier-77 must be attached to the procedure code to indicate a repeat surgical procedure by a different surgeon. The use of modifier-77 must be substantiated by documentation.
- A procedure or treatment that is related to the original surgery requires an unplanned return to the operating room. Modifier-78 must be attached to the surgical code to indicate an unplanned return to the operating room.
- A procedure or service that is unrelated to the original surgery. Modifier-79 must be attached to the procedure code to indicate the surgery is unrelated to the original procedure.
- A staged surgical procedure (one that was planned at the time of the original surgery) was performed during the postoperative period of the original surgery. Modifier-58 must be attached to the procedure code to indicate a staged procedure.
- Splinting and cast supplies
It is important to exercise caution when seeing patients during the global period of any Orthopedic surgery. Even when you are certain that a medical procedure is exempted from the global period, double-checking the procedure can help avoid potential billing errors.
Check the Global Period for Patient Care
The primary reason to care about whether a patient is still in the global period following an Orthopedic surgery is that it affects how clinicians report and bill patient visits during that time. Different modifiers need to be attached to the current procedural terminology (CPT) code for a visit that is related to a treatment-related procedure in the global period than one that is exempted or unrelated. Filing the wrong code or forgetting to attach the appropriate modifier can lead to a charge being rejected. It may also delay payment when a third-party payer asks for medical record documentation.
It could be difficult for an Orthopedic practice owner to stay on top of all billing updates as his major focus is on patient care. MedicalBillersandCoders can help you with inaccurate billing and coding activities. For more information on our Orthopedic billing and coding services, please get in touch with us!