Can you really manage medical billing without understanding its essential rules and special terms? The global period is one such common term. It is a key component of global surgery, a concept introduced by Medicare to cover comprehensive surgical procedures. So, what exactly is a global period in medical billing?
It is a specific timeframe during which all the necessary surgical procedures, including all post-operative services and visits, are bundled within the same claim. In simple words, payers cover them under a single payment.
Therefore, a healthcare provider cannot bill them separately. This global period can vary depending on the type of operation. It is usually around 0, 10, or 90 days. Let’s get into the details!
Significance of Global Period in Medical Billing
Many surgery patients usually stay in the hospital for a few days after the procedure. This period includes many follow-up services, such as evaluation and management, to help patients recover faster. These are all bundled into the global surgery fee. The global period, starting with a surgical procedure and ending after some time of the operation, has a significant role in medical billing.
Overall, it helps healthcare providers avoid denials due to duplicate medical claims. It not only balances surgical costs for patients, but it also simplifies the entire billing process for healthcare providers. In short, the global period is important in medical billing for the following reasons:
- It standardizes the billing process for surgeries, simplifying the entire process.
- It clarifies all the misunderstandings about insurance coverage, helping healthcare providers identify all covered services within the global surgical payment.
- It reduces the administrative load on healthcare professionals by combining related services under one bill.
- It promotes high-quality patient care during the surgical and recovery phases by reducing the billing of the follow-ups.
- Lastly, it protects patients from unexpected out-of-pocket costs.
Services Provided Under the Global Period
Medicare has a set global period for both minor and critical surgeries. According to the Centers for Medicare & Medicaid Services (CMS), a major surgery’s global period lasts up to three months (90 days) and starts a day before the operation.
On the other hand, minor surgeries, such as mole removals, biopsies, and more, have a global timeframe of only 0 or 10 days, including the day of the operation.
This timeframe includes all the care services related to the surgical procedure, such as:
Pre-Operative Services
- Pre-surgical consultation (one day before major surgeries or on the day of minor surgery). These services generally include visits after the decision to operate is made.
Intraoperative Services
- Surgical procedure (major or minor)
- Anesthesia services
- Surgical assistance services provided by other doctors, including wound closure, bleeding control, and more
Post-Operative Services
- Wound care services such as changing the dressing
- All the evaluation and management services related to the surgery, including checking the patient’s vital signs and analyzing post-surgical symptoms
- Handling post-surgery complications
- Removing cutaneous sutures, staples, casts, splints, and tubes
- Pain management treatments/services
Remember that this global period applies to every healthcare provider who has participated in the surgical operation, including surgeons, physicians, and anesthesiologists. Moreover, it only includes related services and excludes:
- Unrelated consultations
- Treatments for other issues
- Emergency services
- Unplanned separate procedures
Global Period Coding for Surgical Procedures
Understanding the concepts of global surgery, like global fee and period, is crucial for avoiding inaccurate coding. Usually, healthcare providers use CPT and HCPCS codes to describe specific surgical procedures.
According to CMS’ global surgery guidelines, physicians who offer the global package should only use the appropriate surgical CPT code within the claim. This CPT code will include all the pre-, intra, and post-operative care services related to the surgery as part of the global package. In simple terms, healthcare professionals cannot bill separate visits or other unrelated services in this package.
Post-Operative Modifiers for Global Period
Billing experts use modifiers to give more details about the services within the global period. For example, doctors use specific modifiers to highlight unrelated treatments or consultations. Here are some of the most common post-operative modifiers in the global period.
Modifier 24 – Unrelated Evaluation & Management Service
Billing specialists use this modifier to specify that the performing physician has provided consultation related to some other issue. In simple terms, it signifies unrelated E/M services to post-operative care.
Modifier 58 – Staged/Related Procedures
This modifier notifies that a procedure or service provided by the same physician in a surgery’s global period was necessary for a patient’s recovery. In short, modifier 58 specifies that the performed procedure was either:
- Staged
- More complex than the original or
- Part of the patient’s post-operative care.
Modifier 78 – Unplanned Return to OR during the Global Period
This modifier is typically used to report unplanned but related returns to the operating room for a patient’s recovery. Billing specialists use the modifier 78 to indicate an unexpected but related procedure to the original surgery.
Modifier 79 – Unrelated Procedure during the Global Period
Modifier 79 is used in the medical claim to highlight an unrelated procedure. Billing experts use this modifier to indicate that the new procedure performed by the same surgeon in the post-operative care has no connection with the original surgery.
Bottom Line
In conclusion, we can say that a global period provides a clear framework for all the covered post-operative services. As part of the global package, it allows patients to receive excellent post-surgical care without worrying about unexpected costs.
We have provided all the relevant information about the global period in medical billing, including its different levels, coding guidelines, and appropriate modifiers so you can use the proper surgical CPT codes and modifiers to receive complete reimbursements.
