The concept of a Global Surgical Package is a standardized method used by healthcare payers, including Medicare, to simplify billing for surgical procedures and the routine care that follows. This bundled payment model ensures that a single fee covers a wide range of services necessary for a patient’s recovery. The goal is to provide a predictable payment structure for the surgeon and to ensure patients receive necessary post-operative management without incurring separate charges for routine follow-up visits.
Defining the Global Period
The Global Period defines the specific timeframe, encompassing the stages before, during, and after an operation, that is included in the single payment for the surgery. This package covers the surgeon’s work from the initial pre-operative assessment through the final stages of routine post-operative care. This system is primarily governed by the Centers for Medicare & Medicaid Services (CMS) but is widely adopted by most private insurance carriers.
For a major operation, the global period begins the day immediately preceding the surgery. For minor procedures, the period typically starts on the day the surgery is performed.
The surgical package includes all services provided by the surgeon or any member of the same specialty within the same group practice. Physicians who share a practice and specialize in the same area must bill and accept payment as a single entity for the bundled services. This prevents patients from receiving multiple bills from different providers within the same group for the same episode of care.
Standard Lengths Based on Procedure Type
The length of the global period is determined by the complexity of the operation and is tied to the specific Current Procedural Terminology (CPT) code assigned to the procedure. There are three standard durations: 90 days, 10 days, and 0 days, corresponding to different levels of surgical intensity.
The 90-day global period is assigned to procedures classified as “Major Surgeries.” These involve complex operations requiring significant resources and an extended recovery, such as a total joint replacement or a coronary artery bypass. For a 90-day procedure, the total time covered is 92 days, including one day before the surgery, the day of the surgery, and the 90 days following the operation.
“Minor Procedures” are assigned either a 10-day or a 0-day global period. A 10-day global period covers the day of the procedure plus the ten days afterward. These procedures are relatively simple, such as a complicated wound repair or the excision of a small tumor, and do not include a pre-operative day.
The 0-day global period applies primarily to diagnostic procedures and some minor endoscopies. For these, the package covers only the service provided on the day the procedure is performed. Any related follow-up office visit occurring on a different day can be billed separately. The CPT code assigned specifies the designated global length using an indicator (090, 010, or 000).
Services Included and Excluded
The Global Surgical Package covers all routine, related care expected during the patient’s recovery period. Included services are designed to manage the patient’s recovery without additional charge. This includes routine follow-up visits with the surgeon to check on healing and progress.
Routine post-operative management is covered, such as:
- Removal of sutures or staples.
- Routine dressing changes.
- Management of pain directly related to the surgical site.
- Management of minor post-operative complications that do not require a return to an operating room or procedure room (e.g., treating an incision site infection with antibiotics in the office).
Services not related to the surgical procedure are explicitly excluded and result in a separate bill. An office visit for an unrelated condition, such as a new skin rash or a flu-like illness, is billable separately. Diagnostic tests (like X-rays or laboratory work), physical therapy, and occupational therapy are typically billed distinctly from the global package. The initial evaluation leading to the decision for major surgery is also often excluded and billed separately.
Understanding Separate Billing for Related Care
Even during the global period, certain services related to the surgery can be billed separately if they fall outside the definition of routine, bundled care. This separate billing is managed through the use of specific modifiers attached to the procedure code. These modifiers communicate to the payer that special circumstances apply, justifying an additional charge.
Unplanned Return to the Operating Room
One scenario involves an unplanned return to the operating room (OR) due to a complication from the initial surgery. If a patient experiences a post-operative hemorrhage or a wound dehiscence requiring a trip back to the OR for correction, this service is billable. The surgeon uses a specific modifier to indicate that the second procedure was necessary to treat a complication related to the first surgery, which allows for separate reimbursement.
Unrelated Surgical Procedure
A second situation is when a patient requires a completely different and unrelated surgical procedure during the global period of the first operation. For example, if a patient has a knee replacement and two weeks later requires an emergency appendectomy performed by the same surgeon, the appendectomy is a separately billable service. A different modifier is used to inform the payer that the second procedure is entirely distinct and unrelated to the original surgery. This ensures the surgeon is compensated for the two separate episodes of care.