Global Period, Post-operative Period and Global Surgical Package
All necessary services provided by a surgeon before, during, and after a procedure within the global period are included in the global surgical package. Payment for the global surgical package is split among the surgeon and physician, when post-op care is transferred from the surgeon to another physician. The Medicare payment will be limited to the same total amount as would have been paid if one physician provided all of the care.
There are three types of global surgical packages:
- 000 – Zero-day Post-operative Period
- 010 – 10-day Post-operative Period
- 090 – 90-day Post-operative Period
The Medicare Physician Fee Schedule provides information on each procedure code, including the global surgery indicator (e.g. 000, 010, 090).
In filing a claim to the Medicare following points should be taken into consideration:
- Reporting the date of surgery as the date of service for subsequent care;
- Indicating the date that care was provided the physician and
- Keeping a copy of the written transfer agreement in the patient?s medical record.
For billing purposes:
- Post-operative visits do not require the same documentation as E/M services provided outside of the global period.
- It is also important to document the face-to-face time spent with the patient or family?for example, in counseling.
- In addition, any diagnostic tests ordered, referrals, or consults recommended should be documented.
- The nature of the patient?s original presenting problem, underlying medical problems, and the severity of the original symptoms all influence the level of medical necessity and follow-up and should be documented post-operatively.
Do’s and Dont’s of reporting during global period:
- The surgeon is not required to submit a claim for visits in the post-operative period.
- Tracking all office E/M services provided in the post-operative period by recording CPT code 99024 (post-operative follow-up visit, normally included in the surgical package, to indicate that an evaluation and management service was performed during a post-operative period for a reason related to the original procedure) is recommended. This code should be applied to all surgeries with 90- and 10-day global periods, thereby indicating that a post-operative visit has occurred. It should be assigned a zero dollar amount because all payment has been received through the single global surgical payment.
- The surgical package was developed based on the typical case; hence, a physician may furnish more or fewer post-operative visits. In either case the global package covers the period of time for 10 or 90 days. However, the physician is prohibited from billing for E/M services in the global period, unless the service is separately identifiable?for example, related to different diagnosis.
- Additionally, if any of the medically necessary post-operative visits are not provided, the original surgery CPT code with modifier 54(surgical care only) must be billed. The physician who takes responsibility for the post-operative visits would also bill the same original surgery CPT code with modifier 55 (post-operative management only).
- Modifier 24(unrelated evaluation and management service by the same physician or other qualified health care professional during the post-operative period) is appended to an E/M service during the global period to indicate that the E/M service is unrelated to the surgery. Modifier 24 is only used when the original procedure had a 10- or 90-day global period. There would be no reason to use it for an E/M service after a procedure with zero global days because no post-operative services are valued into these procedures.
- Regardless of whether a global surgical package has been developed to include a typical number of post-operative services, a physician may furnish more or fewer post-operative visits.