Global Surgery - JE Part B

Access the below related information from this page.

• Overview
• Medicare Physician Fee Schedule (MPFS) Lookup Tool
• Billing
• Included Services
• Excluded Services

Global Period Overview

There are three types of global surgical packages based on the number of post-operative days.

1. Zero Day Post-operative Period
   • No pre-operative period
   • No post-operative period
   • Visit on day of procedure is generally not payable as a separate service
2. 10-day Post-operative Period
   • No pre-operative period
   • Visit on day of procedure is generally not payable as a separate service
   • Total global period is 11 days. Count the day of the surgery and 10 days following the day of surgery
3. 90-day Post-operative Period
   • One day pre-operative included
   • Day of the procedure is generally not payable as a separate service
   • Total global period is 92 days. Count one day before the day of surgery, the day of surgery, and 90 days immediately following the day of surgery

Medicare Physician Fee Schedule (MPFS) Lookup Tool

Information on each procedure code, including the global surgery indicator, is available on the Medicare Physician Fee Schedule Search webpage.

• Codes with "000" are endoscopies or minor surgical procedures (zero day post-operative period)
• Codes with "010" are other minor surgeries (10-day post-operative period)
• Codes with "090" are major surgeries (90-day post-operative period)

Codes with "ZZZ" are add-on surgical codes that are always billed with another service. There is no post-operative work for these codes.

Billing

Physicians in Group Practice

When different physicians in a group practice participate in the care of the patient, the group bills for the entire global package if the physicians reassign benefits to the group. The physician who performs the surgery is shown as the performing physician.

Physicians Who Furnish Part of a Global Surgical Package

Both the bill for the surgical care only and the bill for the postoperative care only, will contain the same date of service and the same surgical procedure code, with the services distinguished by the use of the appropriate modifier.

Providers need not specify on the claim that care has been transferred. However, the date on which care was relinquished or assumed, as applicable, must be shown on the claim. This should be indicated in the remarks field/free text segment on the claim form/format. Both the surgeon and the physician providing the postoperative care must keep a copy of the written transfer agreement in the beneficiary's medical record.

Where a transfer of postoperative care occurs, the receiving physician cannot bill for any part of the global services until he/she has provided at least one service. Once the physician has seen the patient, that physician may bill for the period beginning with the date on which he/she assumes care of the patient.

Exceptions

• Where a transfer of care does not occur, occasional post-discharge services of a physician other than the surgeon are reported by the appropriate evaluation and management code. No modifiers are necessary on the claim.
• If the transfer of care occurs immediately after surgery, the physician other than the surgeon who provides the in-hospital postoperative care bills using subsequent hospital care codes for the inpatient hospital care and the surgical code with the "-55" modifier for the post-discharge care. The surgeon bills the surgery code with the "-54" modifier.
• Physicians who provide follow-up services for minor procedures performed in emergency departments bill the appropriate level of office visit code. The physician who performs the emergency room service bills for the surgical procedure without a modifier.
• If the services of a physician other than the surgeon are required during a postoperative period for an underlying condition or medical complication, the other physician reports the appropriate evaluation and management code. No modifiers are necessary on the claim. An example is a cardiologist who manages underlying cardiovascular conditions of a patient.

Date(s) of Service

Physicians, who bill for the entire global surgical package or for only a portion of the care, must enter the date on which the surgical procedure was performed in the "From/To" date of service field. This will enable carriers to relate all appropriate billings to the correct surgery. Physicians who share postoperative management with another physician must submit additional information showing when they assumed and relinquished responsibility for the postoperative care. If the physician who performed the surgery relinquishes care at the time of discharge, he or she need only show the date of surgery when billing with modifier "-54."

However, if the surgeon also cares for the patient for some period following discharge, the surgeon must show the date of surgery and the date on which postoperative care was relinquished to another physician. The physician providing the remaining postoperative care must show the date care was assumed.

Physicians Furnishing Less Than the Full Global Package

There are occasions when more than one physician provides services included in the global surgical package. It may be the case that the physician who performs the surgical procedure does not furnish the follow-up care. Payment for the postoperative, post-discharge care is split between two or more physicians where the physicians agree on the transfer of care.

When more than one physician furnishes services that are included in the global surgical package, the sum of the amount approved for all physicians may not exceed what would have been paid if a single physician provides all services (except where stated policies, e.g., the surgeon performs only the surgery and a physician other than the surgeon provides preoperative and postoperative inpatient care, result in payment that is higher than the global allowed amount).

Where a transfer of care does not occur, the services of another physician may either be paid separately or denied for medical necessity reasons, depending on the circumstances of the case.