Billing for Global Surgical Packages

Billing for global surgical packages  

… also referred to as global surgical procedure can be tricky if you don’t understand what it means and how to be billing for global surgical packages.

Let’s try to understand what global surgical packages means. You have to remember that when you are billing for global surgical packages, it is already inclusive  with almost all necessary services that the surgeon would render surgeon prior to, in the course of, and also from a procedure. Treatment repayment for your surgical treatment incorporates the preoperative, intra-operative and also post-operative providers routinely carried out by the surgeon or perhaps simply by people on the
identical collection while using identical area of expertise. Health professionals inside the identical collection train who are inside the identical area of expertise should
bill and be paid for as if they were 1 medical doctor.



Here are the 3 Different Scenarios when Billing for Global Surgical Packages

“0” Day (Zero-day global procedures)





Procedures performed with “0” global days that don’t have a Pre-Op or Post-Operative  period. But you can not bill for an E/M encounter when rendered on the same day of the procedure and is related with the surgery. Modifier 57 will not in this scenario.

10-day: The 10 days surgical global period.

This include 11 full days which begins from the day of the surgery plus the 10 following days of the surgery. There is no Pre-operative included in this global days. Most of the minor surgical procedures has 10-days global surgical days – CPT  46221 (Hemorrhoidectomy, internal, by rubber band ligation(s)) is a very good example of a minor surgical procedure which has a 10 days global.

90-day:  The 90 days surgical global has 92 days in total.

This includes – one day before the procedure, the day of the surgery, and the 90 days of Post-OP care immediately following the surgery. You’ll find that major surgical procedures carry a 90-day global period, such as 49653 Laparoscopy, surgical, repair, ventral, umbilical, spigelian or epigastric hernia (includes mesh insertion, when performed); incarcerated or strangulated.

Take note that during the global days, you can not bill for a separate Evaluation and Management when your Surgeon is providing care during a normal pre-operative, surgical, or post-operative period, and also during the Post-Operative period that is related to the patient recovery from the surgery, including pain management.

Meaning, during the 90 days global period – you can not bill for an E/M if it is related to the surgery. Let me give you a good example – your surgeon performed an appendectomy on a patient and we know that CPT  44950 (Appendectomy) has a surgical global days of 90 days. After a week, the patient came back to your office complaining of abscess formation in the area of the removed appendix or on surgical incision site. The Surgeon will take of this problem but this encounter is non-billable because it is related to the surgery and it is still within the 90 days global period.



I hope this article did help you understand the billing for billing for global surgical packages.

According to the AMA who owns CPT:  The surgical package is inclusive of the following:

Very important to know when billing for global surgical packages procedures.

  1. The Surgical Procedure
  2. Local infiltration, metacarpal/metatarsal/digital block or topical anesthesia;
  3. One related evaluation and management (E/M) encounter (including history and physical) that occurs after the decision for surgery has been made and is either on the date immediately prior to the procedure or on the actual date of the procedure;
  4. Immediate postoperative care, including dictating operative notes and talking with the family and other physicians;
  5. Writing orders;
  6. Evaluating the patient in the postanesthesia recovery area;
  7. Typical postoperative follow-up care.

    CPT states that “typical postoperative follow-up care” includes “only that care which is usually a part of the surgical service. Complications, exacerbations, recurrence, or the presence of other diseases or injuries requiring additional services should be separately reported.” This means that, from a CPT perspective, the global surgical period extends from no more than one day before the day of the procedure to as long as is necessary for typical postoperative follow-up care to be completed. In essence, the postoperative period is open-ended.

 References:

Billing for global surgical packages

Chapter 12 – Physicians Nonphysician Practitioners (see 40.1 – Definition of a Global Surgical Package)

How to Use Billing Modifiers in Medical Coding



 

 

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