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What is NOT Included in the Global Package
March 28, 2017
Don’t lose out on revenue due to a misunderstanding of what you are allowed to bill that is not included in the global surgery payment. There are many services that may be billed and paid for separately.
NOTE: The initial evaluation for minor surgical procedures and endoscopies are included in the global surgery package.
Services not included in the global package, which can be billed for separately, include:
The initial consultation or evaluation to determine the need for the surgery;
Appending a modifier 57 (Decision for Surgery), can ensure reimbursement.
Visits by the same physician on the same day as the surgery or endoscopy are included in the global package;
If there is an entirely separate encounter for evaluation and management you may bill the visit with Modifier 25.
Services of other physicians related to the surgery, except where the surgeon and the other physician(s) agree on the transfer of care. This agreement may be in the form of a letter or an annotation in the discharge summary, hospital record, or ASC record.
Visits unrelated to the diagnosis for which the surgical procedure is performed, unless the visits occur due to complications of the surgery.
Treatment for the underlying condition or an added course of treatment which is not part of normal recovery from surgery.
Diagnostic tests and procedures, including diagnostic radiological procedures;
Clearly distinct surgical procedures that occur during the post-operative period which are not re-operations or treatment for complications.
Treatment for post-operative complications requiring a return trip to the Operating Room (OR).
An OR, for this purpose, is defined as a place of service specifically equipped and staffed for the sole purpose of performing procedures. The term includes a cardiac catheterization suite, a laser suite, and an endoscopy suite. It does not include a patient’s room, a minor treatment room, a recovery room, or an intensive care unit (unless the patient’s condition was so critical there would be insufficient time for transportation to an OR).
Global day resources are available with our Professional package and will be found on any code information page.
With your Find-A-Code account you can use our Global days calculator to find out when a global day period ends. Try ithere. Don't have a Find-A-Code account? Sign up for ourfree 28 trail and try the Global Day calculator and much more.
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