Global period is very important since many small services can be included in this period. But, many medical coders still don’t know how to find the global period of any CPT code. Procedure codes can have 0, 10 & 90 days global period. Depending of the global period of the CPT code, the medical coders have to use some specific modifiers as well which help in proper billing of the claim. Their are some modifiers which are used in the postoperative period those also we will see in this post. First we will see how we can find the global period of any CPT code.

How to find Global period of any CPT code

First we have visit the CMS website or you can click the below link which will lead to look-up tool.

https://www.cms.gov/medicare/physician-fee-schedule/search

In this tool you have to select information as shown below and search any CPT code like 27446 and search. You will results shown as below.

As you can see in the images, the Global column shows 90 days. So, the CPT code 27446 Revision of knee joint, has 90 days global period. This is the easiest way we can find global period of any CPT code.

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Modifiers used in Postoperative period

78, 58 and 79 modifiers are used commonly in the postoperative period with CPT code. So, if a any service is  performed during global period like 10 or 90 days these modifiers should be used as per CPT coding guidelines. Let us check how these modifiers can be used in global period with CPT modifiers.

Use of 78 modifier

Now, suppose CPT code 27446 which has 90 days global period, this procedure is performed on RT knee for fracture reduction on 1st May.

Now, again on RT knee some complication happens to the fracture site within 90 days global period after 1st May, and the patient comes for an unplanned visit and again some procedure is performed or any sugery. Then that CPT code or surgery procedure code will be appended with 78 modifier.

78 modifier– Unplanned return to the operating or procedure room, by the same physician, following an initial procedure for a related procedure during the post-operative period.

So, if an unplanned return to the same physician or same department for any diagnosis related to the initial procedure during the postoperative period or global period, 78 modifier should be used.

Any follow up visit or E/M visit done related to the initial procedure during the global period will be inclusive in the primary or initial procedure, and should not be reported separately.

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Use of 79 modifier

Now, suppose the patient return to the same physician or same department for any diagnosis related to LT leg. Now, the initial exam is performed on RT leg for fracture reduction (CPT 27446) but now the diagnosis or visit for RT leg. Now, if any procedure is performed unrelated to the initial procedure we will append 79 modifier to the CPT code.

79 – Unrelated procedure or service by the same physician during the postoperative period.

The only difference between 78 and 79 modifier is, 78 modifier is appended when an unplanned return happened for any diagnosis related to initial procedure, while in 79 modifier, the unplanned return of patient happened for any diagnosis unrelated to the initial procedure.

Now, suppose an E/M visit happened during the global period for any unrelated diagnosis related to initial procedure. then that E/M visit should be appended with 24 modifier, to get it paid from payer.

Since, this E/M visit is different from the follow up visit E/M service. Any followup visit is done to check the progress of the patient condition after the initial procedure or surgery is performed, which is totally included in the payment of initial surgery CPT code.

But, if any E/M visit unrelated to the initial procedures is performed when can append 24 modifier to that E/M visit code.

Use of 58 modifier

When the initial procedure is performed and the physician planned for another procedure related to initial procedure within global period, then that planned visit CPT code will be appended with 58 modifier.

58 – A staged or related procedure performed during the postoperative period of the first procedure by the same physician.

For example, A procedure (global period is 90 days) is performed on 1st June and B procedure is planned on 20th june by physician, then B procedure CPT code will be appended with 58 modifier to get it paid. Here, B procedure is related to initial procedure A only. A followup procedure is done here hence it is planned before only.

78 and 58 modifier has a small difference here, 78 modifier says unplanned visit while 58 modifier description says staged or related procedure which is already planned by physician.