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Medical Coding - Surgical Status Indicators

Vijayarani Sivakumar

Published On - April 01, 2020

Is the global surgery payment restricted to hospital inpatient settings?

Global surgery applies in any setting, including an inpatient hospital, outpatient hospital, Ambulatory Surgical Center (ASC), and physician’s office. When a surgeon visits a patient in an intensive care or critical care unit, Medicare includes these visits in the global surgical package.

How is Global Surgery classif?ied?

There are three types of global surgical packages based on the number of post-operative days.

 0-Day Post-operative Period (endoscopies and some minor procedures).

 • No pre-operative period

• No post-operative days

• Visit on day of procedure is generally not payable as a separate service

10-Day Post-operative Period (other minor procedures).

 • No pre-operative period

• Visit on day of the procedure is generally not payable as a separate service.

• Total global period is 11 days. Count the day of the surgery and the 10 days immediately following the day of the surgery.

90-day Post-operative Period (major procedures).

 • One day pre-operative included

• Day of the procedure is generally not payable as a separate service.

 • Total global period is 92 days. Count 1 day before the day of the surgery, the day of surgery, and the 90 days immediately following the day of surgery.

Codes with “000” are endoscopies or some minor surgical procedures (zero day post-operative period).

Codes with “010” are other minor procedures (10-day post-operative period).

Codes with “090” are major surgeries (90-day post-operative period).

Codes with “YYY” are contractor-priced codes, for which MACs determine the global period.

The global period for these codes will be 0, 10, or 90 days. Note: not all contractor-priced codes have a “YYY” global surgical indicator. Sometimes the global period is specified as 000, 010, or 090.

While codes with “ZZZ” are surgical codes, they are add-on codes that you must bill with another service. There is no post-operative work included in the MPFS payment for the “ZZZ” codes. Payment is made for both the primary and the add-on code(s), and the global period assigned is applied to the primary code. There are times when the modifier 26 may be appropriate for use with the global surgery indicator of “ZZZ

What services are not included in the global surgery payment?

The following services are not included in the global surgical payment. These services may be billed and paid for separately:

 • Initial consultation or evaluation of the problem by the surgeon to determine the need for major surgeries. This is billed separately using the modifier “-57” (Decision for Surgery). This visit may be billed separately only for major surgical procedures.

The initial evaluation for minor surgical procedures and endoscopies is always included in the global surgery package. Visits by the same physician on the same day as a minor surgery or endoscopy are included in the global package, unless a significant, separately identifiable service is also performed. Modifier “-25” is used to bill a separately identifiable evaluation and management (E/M) service by the same physician on the same day of the procedure.

A new post-operative period begins with the subsequent procedure. This includes procedures done in two or more parts for which the decision to stage the procedure is made prospectively or at the time of the first procedure.

How are minor procedures and endoscopies handled?

 Minor procedures and endoscopies have post-operative periods of 10 days or zero days (indicated by 010 and 000, respectively). For 10-day post-operative period procedures, Medicare does not allow separate payment for post-operative visits or services within 10 days of the surgery that are related to recovery from the procedure. If a diagnostic biopsy with a 10-day global period precedes a major surgery on the same day or in the 10-day period, the major surgery is payable separately. Services by other physicians are generally not included in the global fee for minor procedures.

GLOBAL SURGERY CODING AND BILLING GUIDELINES

 Physicians Who Furnish the Entire Global Package

 Physicians who furnish the surgery and furnish all of the usual pre-and post-operative care may bill for the global package by entering the appropriate CPT code for the surgical procedure only. Separate billing is not allowed for visits or other services that are included in the global package. When different physicians in a group practice participate in the care of the patient, the group practice bills for the entire global package if the physicians reassign benefits to the group. The physician who performs the surgery is reported as the performing physician.

Significant, Separately Identifiable E/M Service by the Same Physician on the Same Day of the Procedure Modifier “-25” (Significant, separately identifiable E/M service by the same physician on the same day of the procedure), indicates that the patient’s condition required a significant, separately identifiable E/M service beyond the usual pre-operative and post-operative care associated with the procedure or service.

• Use modifier “-25” with the appropriate level of E/M service.

• Use modifiers “-24” (Unrelated E/M service by the same physician during a post-operative period) and “-25” when a significant, separately identifiable E/M service on the day of a procedure falls within the post-operative period of another unrelated procedure.

Unrelated Procedure or Service or E/M Service by the Same Physician During a Post-operative Period

Two CPT modifiers are used to simplify billing for visits and other procedures that are furnished during the post-operative period of a surgical procedure, but not included in the payment for surgical procedure. These modifiers are:

• Modifier “-79” (Unrelated procedure or service by the same physician during a post-operative period). The physician may need to indicate that a procedure or service furnished during a post-operative period was unrelated to the original procedure. A new post-operative period begins when the unrelated procedure is billed.

• Modifier “-24” (Unrelated E/M service by the same physician during a post-operative period). The physician may need to indicate that an E/M service was furnished during the post-operative period of an unrelated procedure. An E/M service billed with modifier “-24” must be accompanied by documentation that supports that the service is not related to the post-operative care of the procedure.