What are the Postoperative Global Periods and What is Included in them?

Minor Surgery:  Any CPT code that has a Global Period of “0” or “10” days is classified as a Minor Surgical Procedure.

Major Surgery: Any CPT code that has a Global Period of “90” days is classified as a Major Surgical Procedure. Why can’t they mean what they say? Even though the Global Periods are stated as “0,” “10,” or “90” days, in reality they are “1,” “11,” and “92” days. For a Global Period of “0,” the Global Period includes the day that the procedure is actually performed. Thus, in reality, “0” really means “1.” For a Global Period of “10,” the Global Period includes the actual day that the procedure is performed and the next 10 consecutive postoperative days. Thus, in reality, “10” really means “11.” For a Global Period of “90,” the Global Period includes the actual day that the procedure was performed, the day BEFORE the procedure was performed, AND the next 90 consecutive postoperative days. Thus, in reality, “90” really means “92.”

Global Policy for Minor Surgeries

Any E/M service performed on the same day, as a Minor Surgery is included in the Surgery fee. An initial (visit) E/M service (99202-99205, 99324-99328, 99281-99285) may be billed using the -25 Modifier on the E/M code. 

ALL intra-operative services such as a local anesthesia, injections, dressings, casts, splints, post-op shoes, wires, pins, supplies, etc. that are a necessary part of a surgical procedure are included in the surgery fee. 

Any and all medical and surgical services related to complications, which do not require a return to the operating room or procedure room, are included in the surgery fee.

All post-op visits, during the 0 or 10 day follow-up period that are related to recovery from the surgery are included in the surgery fee. 

Any post-op pain management services directly related to the surgery are included in the surgery fee.

All hospital admission and discharge reports, including the surgeon’s H & P are included in the surgery fee.

Any anesthesia (local, regional, and general) provided by the surgeon are included in the surgery fee.

You may bill for any pre-operative consultations by a non-surgeon.

You may bill for any surgical procedure that requires a return to the operating room or procedure room (use Modifier -78 on the surgical code).

You may bill for any post-op injectable drugs (materials only) by using the appropriate J code. Bill to MAC. 

You may bill for any splint or casting supplies used post-op by using the Q codes as appropriate. Bill to MAC.

You may bill for any devices for fractures or dislocations used post-op (ie CAM WALKER) by using the appropriate L code. Bill to DMERC.

Global Policy for Major Surgeries

The preoperative visit on the same day or one day prior to the day of surgery is included in the surgery fee.

An initial (visit) E/M service (99202-99205, 99324-99328, 99281-99285) may be billed using the -57 Modifier on the E/M code.

You may bill a separately identifiable procedure on the same day by using the -57 Modifier on the E/M code.

For a major surgery, you may use the -57 Modifier to bill for the service to decide to perform the surgery, if it occurs the day before or day of major surgery. If the decision to perform surgery is made at the time of a consultation, you may bill the E/M code with the -57 Modifier.

ALL intra-operative services such as a local anesthesia, injections, dressings, casts, splints, post-op shoes, wires, pins, supplies, etc. that are a necessary part of a surgical procedure are included in the surgery fee.

Any and all medical and surgical services related to complications, which do not require a return to the operating room or procedure room, are included in the surgery fee.

All post-op visits, during the 90 day follow-up period that are related to recovery from the surgery are included in the surgery fee.

Any post-op pain management services directly related to the surgery are included in the surgery fee.

All hospital admission and discharge reports, including the surgeon’s H & P are included in the surgery fee.

Any anesthesia (local, regional, and general) provided by the surgeon are included in the surgery fee.

You may bill for any pre-operative consultations by a non-surgeon.

You may bill for any surgical procedure that requires a return to the operating room or procedure room (use Modifier -78 on the surgical code).

You may bill for any post-op injectable drugs (materials only) by using the appropriate J code. Bill to MAC.

You may bill for any splint or casting supplies used post-op by using the Q codes as appropriate. Bill to MAC.

You may bill for any devices for fractures or dislocations used post-op (ie CAM WALKER) by using the appropriate L code. Bill to DMERC.

This is my opinion.

Michael G. Warshaw

DPM, CPC

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