Understanding Global Period for Orthopedic Surgery

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Understanding Global Period for Orthopedic Surgery

• Basics of Global Period
• In Orthopedic surgery, the global period can be
  an important consideration for the billing of
  services. A global period is a period of time
  starting with a surgical procedure and ending
  some period of time after the procedure. Many
  surgeries have a follow-up period during which
  charges for normal postoperative care are bundled
  into the global surgery fee.
• Reimbursement for surgical procedures includes
  payment for all related services and supplies
  that are routine and necessary to perform the
  procedure. These components of the surgical
  package are not eligible for separate
  reimbursement and will be denied if billed within
  the global period of the associated procedure.
• In the Centers for Medicare Medicaid Services
  (CMS) Global Surgery Booklet, there are three
  different levels of global surgical packages
  that CMS recognizes
• 0-day post-operative period This is the
  classification for extremely minor procedures
  i.e., ones that have no pre-op period and are not
  generally billable as a separate service. The
  most common example would be endoscopies.

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Understanding Global Period for Orthopedic Surgery

• 10-day postoperative period This global period
  definition is similar to 0-day periods in those
  procedures that have this classification have no
  pre-op period and that the visit on the day of
  the procedure is not billable as a separate
  service.
• 90-day postoperative period This is the
  classification for major Orthopedic surgery
  procedures that include pre-operative periods.
  Although the title says it is a 90-day period, it
  is technically 92 days. As the CMS booklet
  states Count 1 day before the day of the
  surgery, the day of surgery, and the 90 days
  immediately following the day of surgery.

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Understanding Global Period for Orthopedic Surgery

• Excluded Services from Global Surgical Package
• Some professional services are not included in
  the reimbursement for a surgical procedure and
  therefore may be eligible for separate
  reimbursement. It may be necessary to append
  an appropriate modifier to the code for the
  service to identify the circumstances which make
  the code eligible for separate reimbursement.
• These services are as follows
• Consultations 
• New patient E/M services 
• An EM service the day before or the day of a
  major surgical procedure only if the initial
  decision to perform the surgery was made during
  that visit. Modifier-57 must be attached to the
  EM code to indicate a decision for surgery. 
• An EM service is provided on the same day as a
  minor procedure only if the EM service is
  unrelated to the procedure performed. Modifier-25
  must be attached to the EM code to indicate the
  EM is significant and separately identifiable. 

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Understanding Global Period for Orthopedic Surgery

• An EM service during the surgical postoperative
  period only if the visit is unrelated to the
  surgical procedure. Modifier-24 must be attached
  to the EM code to indicate the EM is unrelated
  to the procedure performed. 
• A repeat surgical procedure by the same surgeon
  was performed on the same day as the original
  surgery, requiring a return trip to the operating
  room. Modifier-76 must be attached to the
  procedure code to indicate a repeat surgical
  procedure. The use of modifier-76 must be
  substantiated by documentation.
• A repeat surgical procedure by a different
  surgeon, on the same day as the original surgery,
  requiring a return trip to the operating room.
  Modifier-77 must be attached to the procedure
  code to indicate a repeat surgical procedure by a
  different surgeon. The use of modifier-77 must be
  substantiated by documentation. 
• A procedure or treatment that is related to the
  original surgery requires an unplanned return to
  the operating room. Modifier-78 must be attached
  to the surgical code to indicate an unplanned
  return to the operating room. 
• A procedure or service that is unrelated to the
  original surgery. Modifier-79 must be attached to
  the procedure code to indicate the surgery is
  unrelated to the original procedure. 

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Understanding Global Period for Orthopedic Surgery

• A staged surgical procedure (one that was planned
  at the time of the original surgery) was
  performed during the postoperative period of the
  original surgery. Modifier-58 must be attached to
  the procedure code to indicate a staged
  procedure. 
• Splinting and cast supplies
• It is important to exercise caution when seeing
  patients during the global period of any
  Orthopedic surgery. Even when you are certain
  that a medical procedure is exempted from the
  global period, double-checking the procedure can
  help avoid potential billing errors.
• Check the Global Period for Patient Care
• The primary reason to care about whether a
  patient is still in the global period following
  an Orthopedic surgery is that it affects how
  clinicians report and bill patient visits during
  that time.
• Different modifiers need to be attached to the
  current procedural terminology (CPT) code for a
  visit that is related to a treatment-related
  procedure in the global period than one that is
  exempted or unrelated.
• Filing the wrong code or forgetting to attach the
  appropriate modifier can lead to a charge being
  rejected. It

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Understanding Global Period for Orthopedic Surgery
may also delay payment when a third-party payer
asks for medical record documentation. It could
be difficult for an Orthopedic practice owner to
stay on top of all billing updates as his major
focus is on patient care. Medical Billers and
Coders (MBC) can help you with accurate
orthopedic billing and coding. Call us
at 888-357-3226 or email us at info_at_medicalbille
rsandcoders.com for more information!