The global period is a concept in medical billing, primarily established by Medicare and adopted by most private insurers. It defines a specific timeframe when all services related to a surgical procedure are bundled into a single payment. This system is designed to standardize the billing process for surgical care, ensuring that providers are reimbursed for a comprehensive package of services rather than billing for each individual visit or service separately. The global period aims to simplify administrative overhead by combining the different phases of a patient’s surgical experience into one financial transaction. Understanding this bundled payment is important for accurate claims processing and for patients to understand their coverage for follow-up care.
Components of the Global Surgical Package
The bundled payment, known as the global surgical package, includes a specific set of services that cannot be billed separately during the defined timeframe. These services cover the patient’s care across three distinct phases: preoperative, intraoperative, and postoperative care. The surgeon receives a single fee intended to cover their work from the decision for surgery through the recovery period.
The preoperative component typically includes any necessary evaluations or consultations that occur immediately before the surgery, often starting one day prior to major procedures. The initial evaluation and management visit that led to the decision to perform the surgery is generally considered separate and billable. The intraoperative phase includes the surgical procedure itself, along with all services directly performed by the surgeon in the operating room.
The postoperative care is the most extensive part of the package and covers all routine follow-up visits related to the patient’s recovery. This includes services such as the removal of sutures or staples, routine dressing changes, pain management performed by the surgeon, and management of minor complications that do not require a return to the operating room.
Determining the Global Period Length
The length of the global period is determined by the complexity and nature of the surgical procedure, which is linked to its specific Current Procedural Terminology (CPT) code. Payers, such as the Centers for Medicare & Medicaid Services (CMS), classify procedures into three categories based on the post-operative period length: 0-day, 10-day, and 90-day periods.
Procedures with a 0-day global period are typically minor procedures, such as endoscopies or certain minor biopsies, and include no pre-operative or post-operative care within the bundle. For these procedures, only the service performed on the day of the procedure is included in the single payment.
Procedures assigned a 010 indicator have a 10-day global period, which applies to other minor surgeries and includes routine post-operative care for ten days following the procedure. Major surgeries, such as a total knee replacement or open-heart surgery, are assigned a 090 indicator and have a 90-day global period. This longest period includes one day of pre-operative care, the surgery itself, and all routine post-operative care for the ninety days immediately following the operation.
Services That Fall Outside the Global Period
While the global package is comprehensive, certain services performed during the global period are considered separately billable exceptions. Procedures that are unrelated to the original surgery are outside the scope of the global period and can be billed independently. For example, treating a patient for a sudden kidney infection during the 90-day recovery period for a hip replacement is not bundled into the surgical fee because it is a separate medical issue.
The surgeon must use a specific billing modifier, such as Modifier 79, to indicate to the payer that a procedure was unrelated to the original surgery, which allows a new global period to begin for the second procedure.
Another exception involves complications that require the patient to return to the operating room (OR) for a procedure. While minor complications treated in the office are included in the bundle, a return to the OR for an unplanned procedure, such as treating a post-surgical hemorrhage, is separately billable using Modifier 78.
Staged or planned procedures are also exceptions, where a subsequent procedure was anticipated at the time of the original operation, such as a multi-stage plastic surgery repair. These planned follow-up procedures are not included in the initial global fee and are indicated using Modifier 58. Additionally, certain diagnostic tests and non-routine procedures, like a pathology consultation, may also be billed separately, as long as they are not explicitly defined as included in the standard surgical package.