Global Days or Period for Surgery CPT

What is Global Days or Period for Surgery CPT codes in Medical Billing and CMS tool link to look up the post-operative period for Surgical procedures?.

Global Days

It is also called as Global Period. It is the period of time during which all the necessary services normally furnished by a surgeon (before, during and after a procedure) are included in the reimbursement for the procedure performed.

Global Surgical Package also called as global surgery.

Global surgery is not restricted to hospital inpatient settings. It applies in any setting such as inpatient hospital, outpatient hospital, ambulatory surgical center and physician’s office. Appropriate modifier should be used to indicate services are not part of the global surgical package for reimbursement.

Let us see the types of Global Surgery package or we can also call it as global days.

They are three types of global surgery package

0 Day Post-Operative period (Code-000)

  • Endoscopic and some minor procedures are included in the fee scheduled payment amount. Evaluation and Management Services on the day of the procedure is generally not reimbursable as a separate service.
  • No Pre-operative period
  • No Post-operative days

 

10 Days Post-Operative period (Code-010)

  • Other minor procedures are included in the fee scheduled payment amount. Evaluation and Management Services on the day of the procedure is generally not reimbursable as a separate service.
  • 10 Days Post-operative days(Count the day of surgery and 10 days immediately following the surgery included in the fee scheduled amount)
  • No Pre-operative period

 

90 Days Post-Operative period (Code-090)

  • Major procedures are included in the fee scheduled payment amount. Evaluation and Management Services on the day of the procedure is generally not reimbursable as a separate service.
  • 90 Days Post-operative days (Count 1 Day before the day of the surgery, the day of surgery and the 90 days immediately following the day of surgery included in the fee scheduled amount).
  • One day pre-operative included.

Below is the CMS tool to check the post-operative periods for covered surgical procedures for Medicare and the insurances which follows CMS guidelines.

http://www.cms.gov/apps/physician-fee-schedule/overview.aspx

When you are checking the post-operative periods for covered surgical procedures under CMS with the above link, please keep in mind that if you find the code as MMM/XXX/ZZZ/YYY in the column (Global) instead of 000/010/090.

XXX – It means the global concept does not apply to the code.

MMM – Maternity Codes (Global period does not apply)

ZZZ – It means the Code is related to another service and is always included in the global period of the other service.

Let us see the below example to better understand

CPT 11045 have ZZZ global days because it is add on code and is related to primary procedure, so this code always included in the global period of the other service. In this need to bill CPT 11045 with primary code.

YYY – Contract priced codes, for which MAC determine the global period.

 

Now let us see if the claim denied as global what needs to be done in order to resolve the issue:

Claim denied as Global

1Call the representative of that particular insurance and ask the below questions:
2Claim received and denied date?
3To which procedure code it is global?
4May I know the date of service( which is applied global)
5Global days for the procedure? or else you can look up through the above link if they follow CMS guidelines.
If DOS<=global daysIf DOS >global days
6Check with them can we submit with appropriate modifier?Clarify with insurance rep that after the global days only the service was performed and send the claim back for reprocess
If yesIf No
7Check with them the appropriate modifier for the procedure code? If rep provides then Call telephonic re-opening line update the modifier and send the claim back for reprocessCan we appeal with Medical Records
Appeal Limit and appeal address and appeal Fax# and attention to
8Claim#
9Finally Cal-Ref#

 

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