Under the Medicare Physician Fee Schedule, surgical services are valued and paid for as part of “global periods” that include the procedure and the services furnished in the periods immediately before and after the surgical procedure. Surgical services are grouped into Minor Surgery (10 day post-operative period) and Major Surgery (90 day post-operative period). CMS will be measuring the number of services delivered during the global period for certain high volume procedures both Minor and Major Surgery.
Read also: How to become 99% perfect in coding Surgery codes
Let us checkout which are the procedures that are categorize in 0, 10 & 90 days global period.
0 day– Endoscopic or minor procedure with related preoperative and postoperative relative values on the day of the procedure only are included in the fee schedule payment amount; E/M services on the day of the procedure are generally not separately reimbursed.
10 days– Minor procedure with preoperative relative values on the day of the procedure and postoperative relative values during a 10 day postoperative period are included in the fee schedule amount; E/M services on the day of the procedure and during the 10-day postoperative period are generally not separately reimbursed.
90 days – Major surgery with a 1-day preoperative period and 90-day postoperative period are included in the fee schedule amount; E/M services on the day of the procedure and during the 90-day postoperative period are generally not separately reimbursed
MMM – Maternity codes; the usual global period concept does not apply. Medica assigns a 42-day global period to certain maternity codes
XXX – Global concept does not apply to the code.
YYY – Subject to individual pricing and determination whether the global concept applies. Medica assigns a 0-day global period to these codes
ZZZ – The code is related to another service and is always included in the global period of the other service. ZZZ codes are add-on codes that must be billed with another service. There is no post-operative work included in the National Physician Fee Schedule payment for the ZZZ codes. The Global Surgical Package concept does not apply to the code.
Modifiers used during Global period
Different modifiers are used during global period. Below are list of modifiers.
24 modifier – Unrelated Evaluation and Management (E/M) Service by the Same Physician During a Postoperative Period
25 modifier– Significant, Separately Identifiable Evaluation and Management Service by the Same Physician on the Same Day of the Procedure or Other Service
58 modifier – Staged or Related Procedure or Service by the Same Physician During the Postoperative Period
Do not use 58 modifier when the MPFSDB indicates XXX global period
78 modifier – Return To The Operating Room For A Related Procedure During The Post Operative Period
Do not use 78 modifier when the MPFSDB indicates XXX global period
79 modifier – Unrelated Procedure or Service by the Same Physician During the Postoperative Period
Do not use 79 modifier when the MPFSDB indicates XXX global period
References: