Global Surgical Package, Global Periods
Understanding the definition for the global surgical package will help in understanding how to use modifiers during the postoperative global periods. There are differences in the way the global surgical package is defined under the AMA?S CPT rules and under Medicare.
According to CPT, the surgical package includes ?typical postoperative care follow up,? the treatment of complications is not included in the surgical package. According to Medicare, all follow up care-including the treatment of complications, is included in the 10 or 90 day global period unless the patient is returned to an operating room for the management of complication.
For a patient requiring extra attention during the surgical period, one will want to append the correct modifier for additional or unusual services to make sure you receive the payment.
Typically, the global surgery period for a given procedure covers pre-op and post-op care, yet special circumstances dictate the need for additional services, which is where utilizing the correct modifier comes in. Being specific with the documentation about the exact procedures, including anatomy as well as decision making, not only will clear documentation but will also strengthen your case in the event of an audit.
Global periods
Medicare defines global periods based on ?minor? and major? procedures, as follows:
- Aminor procedure has a 0- or a 10-day global period.
- Amajor procedure has a 90-day global period.
A 0-day procedure includes no payment for follow-up care (eg, a major joint injection).
A 10-day global period includes payment for follow-up care for 10 days after the surgical procedure (eg, complex wound repair).
A 90-day global period includes payment for all follow-up care beginning the day after surgery and for the next 90 days unless the condition requires a return to an approved operative suite (Medicare).
Postoperative surgical modifiers:
The following three modifiers may be appended to surgical CPT codes to indicate that an unrelated surgical procedure is being reported, while the patient is covered by a global period:
- Modifier 58: Staged or related procedure or service by the same physician or other qualified healthcare professional during the postoperative period
- Modifier 78: Unplanned return to the operating/procedure room by the same physician or other qualified healthcare professional following initial procedure for a related procedure during the postoperative period
- Modifier 79: Unrelated procedure or service by the same physician or other qualified healthcare professional during the postoperative period.