PBN primer: Know your global surgery rules and get paid correctly

Why This Topic Matters

Global surgery rules affect whether services are bundled into the surgical payment or billed separately. Understanding the article helps coding and reimbursement professionals reduce denials, avoid unbundling, and recognize when Medicare surgical billing follows different conventions than commercial plans.

Article Sections

1. Global surgery basics and Medicare global periods

   Introduces the Medicare framework for global surgery payment and the general categories of global periods used for surgical codes. It also notes how add-on surgical codes are treated within the overall billing structure.

2. Medicare rules more stringent

   Discusses the difference between Medicare and broader CPT-oriented follow-up concepts, with emphasis on postoperative services and the limits of separate billing under Medicare. It frames the article’s comparison between payer policies.

3. Decision for surgery is payable

   Covers preoperative evaluation timing and when an encounter may be considered separately reportable because it leads to the decision to perform surgery. It also addresses medically necessary preoperative visits outside the global period.

4. Underlying causes still billable

   Explains the distinction between follow-up care tied to the procedure and care for underlying conditions that remain active after surgery. It includes a clinical example illustrating that distinction.

5. Transfer of care

   Describes how postoperative and preoperative management may be divided when care is transferred between physicians. It also addresses the billing structure used when different clinicians handle different portions of surgical care.

6. Included in the global period surgery payment

   Summarizes the broad service categories Medicare includes in a global surgery package. The section outlines common perioperative services, complications, postoperative care, and routine supplies or related procedures.