The Global Surgical Package is a standardized billing framework designed to simplify surgical care payment. This package bundles the surgical procedure, anesthesia, and all necessary related follow-up care into a single payment, establishing a defined timeframe known as the global period. This system prevents separate charges for every expected pre-operative and post-operative visit, streamlining paperwork for providers and insurance companies.
The Definition of Minor Procedure Periods
For billing purposes, especially as defined by the Centers for Medicare & Medicaid Services (CMS), minor procedures are assigned one of two specific global periods: a 0-day or a 10-day post-operative period. These two timeframes distinguish minor procedures from major surgeries, which generally carry a much longer 90-day global period.
The 0-day post-operative period is typically used for very minor procedures, such as endoscopies, or highly localized procedures like the removal of a small skin tag. For procedures with a 0-day global period, the single payment covers the procedure itself and any follow-up care provided only on the day of the surgery. Any visits or care required on subsequent days are generally considered separate services and may be billed separately.
The 10-day post-operative period is the more common designation for standard “minor surgery,” which includes procedures like a simple biopsy, mole removal, or a minor fracture repair. This global period begins on the day of the procedure and lasts for the following 10 days, covering a total of 11 calendar days. During this time, all routine follow-up care related to the surgery is included in the initial surgical fee.
Services Considered Part of the Global Fee
The single fee paid for a minor procedure covers not only the actual operation but also a defined set of services that are considered routine for recovery during the 0- or 10-day global period. All necessary pre-operative visits occurring on the day of the procedure are included, as is the local infiltration, topical, or digital block anesthesia administered by the surgeon.
Post-surgical pain management provided by the surgeon and any immediate care, such as dictating operative notes or evaluating the patient in the recovery area, are also part of the packaged payment. The fee covers all typical post-operative follow-up visits specifically related to the patient’s recovery from the surgery.
The global fee includes services for wound care, such as the removal of sutures, staples, dressings, and local incision care. Even the management of minor complications that do not require an unplanned return to the operating room is included in the original payment. This inclusion is based on the expectation that minor issues, such as a localized wound infection managed in the office, are a normal part of the surgical risk.
Situations That Allow for Separate Billing
While the global period covers most related services, two main exceptions allow a provider to bill a patient separately, even within the 0- or 10-day timeframe. The first exception is for any care related to an illness or condition that is completely unrelated to the original surgical procedure. For instance, if a patient who had a minor skin procedure returns five days later with a severe case of influenza, the visit for the flu is a distinct medical service and can be billed separately.
The second major exception is for the management of complications that require an unplanned return to the operating room (OR) or a similarly equipped procedural suite. If a post-operative complication, such as significant bleeding or the need for a secondary procedure, requires the patient to be taken back to the OR, this new procedure is considered a separate service. This constitutes a new surgical event and will generally begin its own new global period.
Distinct procedures performed on the same day as the initial surgery or during the global period can be billed separately. These separately identifiable services must be significant and go beyond the usual pre-operative and post-operative care associated with the initial procedure. Appropriate modifiers must be used on the claim to indicate that the service was separate and not automatically bundled into the global package.