Claire Dawson
The global surgical package, also known as global surgery, includes all services typically provided by a surgeon before, during, and after a procedure. The global period varies depending on the type of surgery, with minor surgeries having a period of 10 days and major surgeries having a period of 92 days. This period includes pre-operative visits, intra-operative services, and post-operative care for complications. Hospital discharge is considered part of the global surgical package, and the surgeon must show the date of surgery and the date postoperative care was transferred to another physician. Payment for post-discharge care is split between the physicians involved in the patient's care.
| Characteristics | Values |
|---|---|
| Definition | The global surgical package, also called global surgery, includes all the necessary services normally furnished by a surgeon before, during, and after a procedure. |
| Global Period | Minor Surgery: 0 or 10 days; Major Surgery: 90 days. In reality, these periods are 1, 11, and 92 days, respectively, as the day of the procedure must be counted. |
| Services Included | Pre-operative visits, intra-operative services, post-operative services, hospital admission and discharge reports, post-op pain management services, and anesthesia. |
| Services Excluded | Visits unrelated to the diagnosis for which the surgical procedure is performed, treatment for the underlying condition, diagnostic tests and procedures, and clearly distinct surgical procedures during the post-operative period that are not re-operations. |
| Billing | The sum of the amount approved for all physicians providing services included in the global surgical package may not exceed what would have been paid for a single physician. |
| Transfer of Care | If the transfer of care occurs immediately after surgery, the physician providing post-discharge care bills using subsequent hospital care codes and the "-55" modifier. The surgeon bills with the "-54" modifier. |
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What You'll Learn
- The global surgical package includes pre-operative, intra-operative, and post-operative services
- The global period is 92 days in total, including the day before surgery and 90 days after
- CPT codes classify minor and major surgeries, with 0, 10, and 90-day global periods, respectively
- Post-discharge care payment is split between physicians when care is transferred
- Hospital discharge management is billed on the day of discharge, unless it is also the day of admission
The global surgical package includes pre-operative, intra-operative, and post-operative services
The global surgical package, also known as global surgery, encompasses all the essential services typically provided by a surgeon before, during, and after a procedure. This package ensures that patients receive comprehensive care throughout their surgical journey. Here's a detailed breakdown of what the global surgical package entails:
Pre-operative Services
Pre-operative services are a crucial aspect of the global surgical package. These services commence after the decision to perform surgery has been made and can include visits and consultations with the surgeon. For major procedures, these pre-operative visits typically take place the day before surgery, while for minor procedures, they occur on the day of surgery. These visits are essential for evaluating the patient's condition, providing necessary instructions, and addressing any concerns or questions the patient may have before the surgery.
Intra-operative Services
Intra-operative services refer to the surgical procedure itself and any necessary services routinely performed during the operation. This includes the surgeon's expertise, surgical equipment, anaesthesia, and any other medical services required to carry out the procedure successfully. These services are considered a usual and necessary part of the surgical package.
Post-operative Services
The global surgical package also includes post-operative care, which can be further divided into immediate postoperative care and follow-up visits. Immediate postoperative care involves tasks such as dictating operative notes and communicating with the patient's family and other healthcare professionals. Follow-up visits during the post-operative period are essential for monitoring the patient's recovery and addressing any complications that may arise. These visits are typically related to the surgery and are included in the global package.
It is important to note that the global surgical package's postoperative period is generally considered open-ended from a CPT perspective, but Medicare assigns specific postoperative global periods based on the type of surgery (90 days for major surgeries and either zero or 10 days for minor surgeries and endoscopies). Services beyond the assigned postoperative global period, even if related to the procedure, are separately billable.
Global Period and Multiple Physicians
When multiple physicians are involved in providing services within the global surgical package, the total payment for all physicians cannot exceed the amount paid if a single physician handled all services. However, if a surgeon performs the surgery and another physician provides preoperative and postoperative inpatient care, the payment may be higher than the global allowed amount. In cases where postoperative care is transferred to another physician, the receiving physician cannot bill for any global services until they assume care of the patient. Payment for postoperative, post-discharge care is typically split between the involved physicians when there is an agreement on the transfer of care.
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The global period is 92 days in total, including the day before surgery and 90 days after
The global surgical package, also referred to as global surgery, is an all-inclusive package that covers all the necessary services typically provided by a surgeon before, during, and after a procedure. The global period is the duration of time that this package covers. For a major surgery, the global period is typically 90 days, but in reality, it is 92 days. This includes the day before surgery and 90 days immediately following the procedure.
During the global period, the surgeon or their team provides pre-operative, intra-operative, and post-operative services. Pre-operative visits the day before surgery are included for major procedures, while for minor procedures, these visits are included on the day of surgery. All hospital admission and discharge reports, including the surgeon's H&P, are part of the surgery fee. Any post-operative pain management services directly related to the surgery are also included.
Post-discharge, the surgeon must indicate the date they relinquish care to another physician if they are involved in the patient's care during this period. Payment for post-operative, post-discharge care can be split between multiple physicians if there is an agreement on the transfer of care. This transfer of care must be documented in a discharge summary, hospital record, or ASC record.
The global period for major surgeries is indicated by the code "090," representing 90 days, while minor surgeries are indicated by "010" for a 10-day period. These periods are not restricted to reporting subsequent inpatient E/M services, but specific modifiers may be required, such as modifier 24 for unrelated E/M services during the post-operative period.
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CPT codes classify minor and major surgeries, with 0, 10, and 90-day global periods, respectively
The global surgical package, also known as global surgery, encompasses all services typically provided by a surgeon before, during, and after a procedure. The global fee covers pre-operative, intra-operative, and post-operative services routinely performed by the surgeon or their specialist group. The global period is defined as the time frame during which a physician may not bill for related office visits.
The CPT (Current Procedural Terminology) codes classify surgeries into minor and major categories, with corresponding global periods. Endoscopies or minor surgical procedures are assigned "000" codes, indicating a zero-day post-operative period. "010" codes are for other minor surgeries with a 10-day post-operative period. Major surgeries are designated with "090" codes and have a 90-day post-operative period.
The length of the global period is determined by the type of surgery, not its complexity. For instance, a laparoscopic cholecystectomy (CPT 47562) is considered a major surgery with a 90-day global period. The CPT procedure code for global periods of 10 or 90 days is used with modifier 55.
During the global period, certain services provided by other physicians related to the surgery may be billed separately. For instance, critical care visits unrelated to the surgical procedure and done postoperatively require modifier FT. If the surgery is unrelated to the original procedure, modifier 79 is used. However, if the surgery is more complex or therapeutic, modifier 58 is applied, and if it addresses postoperative complications, modifier 78 is used.
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Post-discharge care payment is split between physicians when care is transferred
The global surgical package, also known as global surgery, encompasses all the necessary services typically provided by a surgeon before, during, and after a procedure. This package includes pre-operative, intra-operative, and post-operative care, often referred to as the global period. The global period covers one day before the surgery, the day of surgery, and 90 days immediately following the surgery.
When it comes to post-discharge care, payment is typically split between multiple physicians when there is a transfer of care. This scenario often arises when the physician who performs the surgery does not provide the follow-up care. In such cases, the payment for post-operative, post-discharge care is divided between two or more physicians based on their agreement regarding the transfer of care. This agreement is usually documented in the form of a letter or a note in the discharge summary, hospital record, or ASC record.
The Centers for Medicare & Medicaid Services (CMS) have developed a single payment system for global surgery, which includes pre-operative, intra-operative, and post-operative services. The CPT® code assigned to the procedure includes a value for post-operative care. The mechanism for splitting the payment between the operating surgeon and the post-op care surgeon involves using modifiers 54 and 55. The surgeon who performs the surgery uses modifier 54, while the post-op care surgeon uses modifier 55. The payer then divides the fee according to the percentages outlined in the Medicare Fee Schedule.
It is important to note that when multiple physicians are involved in the global surgical package, the total payment for all physicians cannot exceed what would have been paid if a single physician provided all the services. However, there are exceptions to this rule, such as when the surgeon only performs the surgery, and a different physician provides preoperative and postoperative inpatient care, resulting in a higher payment than the global allowed amount.
In cases where the transfer of care occurs immediately after surgery, the physician providing in-hospital postoperative care uses subsequent hospital care codes for inpatient care and the surgical code with the "-55" modifier for post-discharge care. The surgeon bills the surgery code with the "-54" modifier. This distinction in coding helps ensure that each physician involved in the patient's care is appropriately reimbursed for their specific services.
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Hospital discharge management is billed on the day of discharge, unless it is also the day of admission
The global surgical package, also known as global surgery, includes all the necessary services typically provided by a surgeon before, during, and after a procedure. This package is designed to streamline billing and provide patients with a more transparent understanding of the costs associated with their surgery. The global period for minor surgeries is typically considered to be 10 days, while for major surgeries, it is 90 days. These periods include the day of the procedure and the days immediately before and after.
During the global period, patients can expect that all hospital admission and discharge reports, including the surgeon's H & P, are included in the surgery fee. Any anesthesia provided by the surgeon and all post-operative visits related to recovery from the surgery are also included. However, it is important to note that hospital discharge management is billed on the day of discharge, unless it is also the day of admission, in which case only the admission service is billed. This is because carriers do not pay for both a subsequent hospital visit and hospital discharge management service on the same day by the same physician.
In some cases, more than one physician may provide services included in the global surgical package. For example, the surgeon who performs the procedure may not be the same person who furnishes the follow-up care. In these instances, payment for post-discharge care is typically split between the physicians involved, and they must show the dates on which care was assumed and relinquished. If a transfer of care occurs immediately after surgery, the physician providing post-operative care bills using subsequent hospital care codes for inpatient care and a specific modifier for post-discharge care.
It is worth noting that there are certain services that are not included in the global surgical package. These can include visits unrelated to the diagnosis for which the surgery is performed, unless they occur due to complications. Treatment for underlying conditions or additional courses of treatment not considered part of normal recovery is also typically excluded. Diagnostic tests and procedures, as well as distinct surgical procedures during the post-operative period that are not related to complications, are generally billed separately.
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Frequently asked questions
The global surgical package, also called global surgery, includes all the necessary services normally furnished by a surgeon before, during, and after a procedure.
The global surgical package includes pre-operative visits, intra-operative services, and post-operative care.
Minor surgery is classified as any CPT code with a global period of 10 days. In reality, this means 11 days, including the day the procedure is performed and the next 10 consecutive post-operative days.
Major surgery is classified as any CPT code with a global period of 90 days. In reality, this means 92 days, including the day before the procedure, the day of surgery, and 90 days immediately following.
No, carriers do not pay for both a hospital visit and hospital discharge management for the same date of service. Only the hospital discharge management code should be paid on the day of discharge, unless it is also the day of admission.
