Let’s talk about global periods. Every surgical Current Procedural Terminology (CPT) code includes a surgical package, aka global period. This includes anything from a laceration repair to earwax removal, from fracture care to a transplant surgery. This surgical package per the CPT guidelines includes the following:
- An Evaluation and Management (E/M) service (either the day of the procedure or the day before the procedure) which includes taking a history and performing an exam
- Local anesthesia
- Immediate postoperative care
- Writing any orders for the patient
- Evaluating the patient in the postop recovery area (if applicable)
- Typical followup care
CMS (aka Medicare) has taken the concept a step further and has defined the post-op period (aka global days) for each CPT code. These are typically 0 days for minor procedure, and 10 or 90 days for more extensive procedures. The assigned global days for each procedure are in the Medicare Physician Fee Schedule. If the patient comes back to be seen or evaluated for any normal post-operative care during this global period, it is not appropriate to bill a separate E/M.
The payment for the CPT code when the procedure is performed includes payment for any follow-up care typically associated with that procedure.
CMS includes all additional services related to the procedure as part of the global period, unless it warrants a return to the operating room. CPT guidelines allow for any services related to complications not considered typical post-op care to be billed separately. It is important to check your payer’s guidelines to determine if a visit is separately billable.
If the patient is seen for an unrelated problem during the global period, these services can be reported with a -24-modifier applied to the E/M code.