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Global Surgery What is the global surgery package?
Single fee
All necessary services normally provided for a procedure
Pre-operative
Intra-operative
Post-operative
One provider
Sometime called a bundle<br>
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Necessary Services Pre-operative visits
Visits after the decision is made to operate
Intra-operative
Services include a usual and necessary part of a surgical procedure
Post-Operative (begins the day after a surgery)
Follow-up visits related to recovery from surgery
Post surgical pain management by surgeon
Treatment for complications
Miscellaneous services<br>
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Examples Misc. Services Common examples
Dressing change
Suture and staple removal
Bedside minor procedure<br>
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One Provider Providers must bill and accept payment as though they’re a single physician
Same group
Same specialty<br>
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Settings Services may be furnished in any setting
Ambulatory Surgical Center (ASC)
Hospital (inpatient and outpatient)
Intensive care or critical care unit
Physician’s office<br>
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Excluded Services Initial evaluation resulting in decision for surgery (major)
Physician’s service in different group practice or different specialty within the same group
Visits unrelated to surgery diagnosis
Diagnostic tests or procedures
Clearly distinct surgical procedures during post-operative period<br>
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More Exclusions Post-operative complications which require return trip to operating room (OR)
Unrelated critical care services for seriously injured or burned patient
Treatment for underlying condition or added course of treatment
Immunosuppressive therapy for organ transplant<br>
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0 Post-Operative Days 000: Visit on the day of the procedure is generally not payable as a separate service
No pre-operative period
No post-operative period<br>
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0 Days Applies Applies to
Endoscopies
Minor procedures
Nail debridement
Remove contraceptive capsule<br>
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10 Post-Operative Days 010: Visit on the day of the procedure is generally not payable as a separate service
Total global period = 11 days
Day of surgery
10 days following
No pre-operative period<br>
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10 Day Applies Other minor procedure
Acne surgery
Some debridement
Some skin tag removals<br>
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90 Post-Operative Days 090: Visit the day before the procedure is generally not payable as a separate service
Total global period = 92 days
Day before the surgery
Day of surgery
90 days following<br>
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90 days Applies Major surgeries
Insert tissue expander(s)
Laparoscopic islet cell transplant
Adjacent tissue transfer or rearrangement<br>
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Other Days Days are set
YYY – global days
Contractors determine the global period
ZZZ – global days
Add-on codes
No post-operative work included in the RVU File
Payment included in the primary procedure
XXX – global days
Concept not applicable<br>
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Locating CMS website
Medicare
Payment
Fee Schedules
Physician Fee Schedule
Look-up
PFS Relative Value Files<br>
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Presubmitted Questions<br>
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Question 1 Detailed rules for Global Period only being 24 hours, many Advantage Plans will not accept the existing explanation as it is very vague. They require a 79 modifier within 90 days or previous surgery to process and reimburse claims. We are unable to comment on Medicare Advantage plans. Each plan has their own system and edits.<br>
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Question 2 At a post op follow up visit would a debridement be included in the global or can we bill the debridement. The surgery has a 90 day global for the original procedure. The biggest questions is the debridement related to the surgery?
Unrelated may be separately considered<br>
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Question 3 Is Medicare going to keep global surgical packages? CMS has provided no indication that this is going away.<br>
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Question 4 When 2 surgeons work on 1 patient doing different parts – modifier? If the surgeons are different specialties, then consider this separately.
Bill the services and Medicare system appends Modifier 51.<br>
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Questions and Answers<br>
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Resources CMS Global Surgery booklet
Medicare Claims Processing Manual, Chapter 12, Section 40 – Surgeons and Global Surgery
Medicare PFS Relative Value Files
Search the Physician Fee Schedule
WPS Global Surgery Coding and Billing Guidelines
WPS Date Calculator
Calculates the 90-day period<br>
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Certificate of Achievement Complete survey
Email contains contact hours<br>
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Follow-up Questions Send your questions by 12:00 PM CT for seven days following the training
Email wps.gha.education@wpsic.com
Subject Line: Today’s Topic
Send claim specific questions to Customer Service<br>
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Survey Let us know what you think!
Take time to complete the survey now.
Survey link in chat
Redirect after closing webinar<br>
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We Hear You We are committed to making changes to improve your education experience.
Based on survey comments
Chapters to YouTube
Training indicators<br>
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Thanks for attending!<br>
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Disclaimers This material is a tool to assist the provider community. Medicare rules change often. Access CMS’ website for current coverage, regulations and rulings.
The basis for answers given today rely on facts given in the question. Medicare rules determine final coverage.
Do not record the event as CMS does not allow this for profit making purposes.<br>
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CPT Copyright Notice CPT codes, descriptions, and other data only are copyright 2024 American Medical Association. All Rights Reserved. Applicable FARS/HHSARS apply. Fee schedules, relative value units, conversion factors and/or related components are not assigned by the AMA, are not part of CPT, and the AMA is not recommending their use. The AMA does not directly or indirectly practice medicine or dispense medical services. The AMA assumes no liability for data contained or not contained herein.<br>
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ADA statement The CDT Code and Nomenclature above have been obtained from Current Dental Terminology (including procedure codes, nomenclatures, descriptors and other data contained therein) (“CDT”). CDT is copyright © 2024 American Dental Association. All rights reserved. Applicable FARS/HHSARS apply.<br>
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AHA & NUBC Copyright Notice Copyright © 2025, the American Hospital Association, Chicago, Illinois. Reproduced with permission. No portion of the AHA copyrighted materials contained within this publication may be copied without the express written consent of the AHA. AHA copyrighted materials including the UB-04 codes and descriptions may not be removed, copied, or utilized within any software, product, service, solution, or derivative work without the written consent of the AHA. If an entity wishes to utilize any AHA materials, please contact the AHA at 312- 893-6816.
Making copies or utilizing the content of the UB-04 Manual, including the codes and/or descriptions, for internal purposes, resale and/or to be used in any product or publication; creating any modified or derivative work of the UB-04 Manual and/or codes and descriptions; and/or making any commercial use of UB-04 Manual or any portion thereof, including the codes and/or descriptions, is only authorized with an express license from the American Hospital Association.
The American Hospital Association (the "AHA") has not reviewed, and is not responsible for, the completeness or accuracy of any information contained in this material, nor was the AHA or any of its affiliates, involved in the preparation of this material, or the analysis of information provided in the material. The views and/or positions presented in the material do not necessarily represent the views of the AHA. CMS and its products and services are not endorsed by the AHA or any of its affiliates.<br>
