The “global period” in medical billing is a predetermined timeframe surrounding a surgical procedure during which payment for the operation covers all related care. This arrangement bundles the costs of the surgery, pre-operative preparation, and routine post-operative recovery into a single payment. The system streamlines billing by preventing separate charges for every follow-up visit or minor service directly related to the procedure.
Defining the Global Surgical Package
The global surgical package provides a comprehensive, single fee that covers an entire episode of surgical care. This bundled approach reduces the administrative burden for both healthcare providers and insurance payers by simplifying the claims process. Only one primary claim is filed for the whole surgical event, rather than submitting multiple claims for each office visit or follow-up service.
The framework for these billing rules is established predominantly by the Centers for Medicare & Medicaid Services (CMS). Most private insurance companies adopt or closely follow the CMS guidelines for their own payment policies. This standardization helps ensure consistent payment across different payers for the same surgical services.
Standardized Timeframes for Procedures
The basis for assigning a global period is the complexity and invasiveness of the procedure, linked to the typical post-operative recovery time. Medical billing uses specific Current Procedural Terminology (CPT) codes to classify procedures, and each code is assigned a global period indicator.
Major surgical procedures are assigned a 90-day global period, indicated by a “090” classification in the fee schedule. This comprehensive package includes one day of pre-operative care, the day of the procedure, and the 90 days immediately following the surgery, totaling 92 days. Examples include major operations like total knee replacement or complex heart surgeries, which require extensive follow-up care.
Other minor procedures are typically assigned a 10-day global period, which is identified by a “010” indicator. This period includes the day of the procedure and the ten days immediately afterward, covering necessary short-term recovery. Procedures like a skin lesion excision or simple wound repair fall into this intermediate category.
The shortest timeframe is the 0-day global period, marked by a “000” indicator, which applies to endoscopies and certain minor surgical procedures. For these procedures, only the services provided on the day of the operation are included in the package. Any follow-up care beyond that day is considered separately billable.
Services Included and Excluded from the Package
The global payment covers a defined set of services directly related to the patient’s recovery from the operation. Included services begin with routine pre-operative visits that occur the day before or the day of the major surgery. The payment covers the actual intra-operative service, the surgical procedure itself, along with all services required in the operating room.
The package also covers all typical post-operative care, such as routine follow-up visits with the surgeon during the specified global period. This includes practical services like dressing changes, removal of sutures and staples, and local incision care. Even if a complication arises that does not require a return to the operating room, the management of that complication by the surgeon is bundled into the original fee.
Services that are not related to the surgery or are outside the normal recovery process are explicitly excluded and may be billed separately. For instance, the initial evaluation visit that leads to the decision for a major surgery is often separate from the package. Diagnostic tests, such as X-rays or lab work, are not included in the global fee. Care for unrelated medical conditions, like routine diabetes management or a new illness that develops during recovery, is also billed outside the surgical package.
Handling Exceptions Through Billing Modifiers
Billing modifiers are two-digit codes appended to a procedure code to communicate that a service performed during the global period is an exception to the bundled rule. The use of modifiers allows providers to maintain the integrity of the global period system while still receiving payment for non-routine or unrelated care.
For example, if a patient requires an evaluation and management service during the post-operative period for a condition entirely unrelated to the surgery, modifier -24 is used to signal this exception. When a patient experiences a complication that requires a return to the operating room for a subsequent procedure, modifier -78 is used to indicate a complication-related procedure. Alternatively, if a second, entirely unrelated procedure is performed during the global period, modifier -79 is utilized to denote the separate nature of the service.