A global surgical package or a global period assists the physicians to claim their receivables in a single payment for all health care services associated with surgical procedure. It is the time spam that is standardized by the third-party payers on the day before the surgery to the successive billing days. Medicare implemented comparable global fee periods as part of the Physician Payment Reform Act in 1992.
- For major surgeries: Medicare applied a global fee period of 1 day before surgery, the day of operation, and 90 days following the date of surgery.
- For minor surgeries: The global fee period is the day of surgery and zero or ten days immediately following the date of surgery.
The Global Surgical Package proposes the terms to expedite hospitals, ambulatory surgery center, or physician’s office. Medicare payment for surgical procedures includes the following services when furnished by the health care providers who perform the surgery:
- Preoperative visits: This term states the appointment of the patient one day before the primary surgery visit and on the day of the minor visit.
- Intraoperative services: The services provided by the surgeons customarily are claimed as intraoperative services.
- Medical and Surgical Services: The complications after surgery of the patient that do not require successive appointments; to the operating room.
- Postoperative Period: The postoperative visits of the patient during the period of the surgery (zero, 10, or 90 days) that are related to recovery after the surgery.
- Supplies: The tools and equipment used; that is related to the surgery.
- Miscellaneous items: This term states to the things; used during the surgical procedure that is related to the operation, such as dressing changes, local incisional care, removal of the operative pack and removal of sutures, staples, lines, wires, tubes or drains.
- Operating room: This entity is defined for this purpose as a place of service specially equipped and staffed for the sole purpose of performing procedures, such as a hospital or ambulatory surgery center operating room, laser suite or dedicated a surgical room in the physician’s office excluding a patient lane or examination room.
The visits performed by the physician for several minors are expected to be claimed as a paid visit on the same day unless a significant, separately identifiable service; performed. For example, an appointment on the same day could be adequately billed in addition to a foreign body removal if a full eye examination made for a patient complaining of pain in and around the eye.
Billing of the visit would not be appropriate if the physician immediately identified the need for epilation trichiasis and only removed the eyelash. A separately identifiable exam performed on the same day as a minor surgery would require a 25 modifier.
There are also occasions when more than one physician provides services included in the global surgical package. Sometimes when a physician performs a surgical procedure and does not furnish the follow-up care, then the payment for the postoperative care is split between two or more physicians when the physicians agree on the transfer of care. When a transfer of care does occur, the services of another physician may be paid separately if medically necessary. Modifiers 54 and 55 would be required to bill co-managed care. Careful monitoring of the global fee periods and correct use of modifiers will help to ensure that all services appropriately billed to Medicare.
Inappropriate billing and division of services could result in redundant denials. In today’s environment of increased Medicare audits, it is more important than ever for services to be correctly billed and in compliance with Medicare regulations.