Medicare_Carriers_Manual / 4823 / 4823

Why This Topic Matters

Global surgery edits can affect whether separately reported services are paid, reviewed, or excluded from prepayment audit. Understanding the article helps support accurate Medicare claim processing and compliance for surgical, postoperative, and related evaluation and management services.

Article Sections

1. Claims Review for Global Surgeries

   Overview of how global surgery claims review is handled under Medicare. Covers the interaction with Correct Coding Initiative edits and the general framework for prepayment review.

2. Prepayment Edits to Detect Separate Billing of Services Included in the Global Package

   Describes the types of services and billing circumstances that are subject to prepayment review when associated with a surgical procedure or endoscopy. Includes discussion of related evaluation and management services and documentation considerations.

3. Exclusions from Prepayment Edits

   Identifies services and billing circumstances that are excluded from the prepayment audit process or treated as exceptions. Also notes additional references for special review situations.