Global Surgery Overview

Introduction

• Document Title: MLN907166 Global Surgery
• Focus: Medicare's global surgery package details.

Key Changes

• Introduction of modifiers (page 9).
• New HCPCS code G0559 for post-operative care by other practitioners (page 9).

Global Surgical Package Definition

• National policy to ensure consistent payment across jurisdictions by Medicare Administrative Contractors (MACs).
• Includes all necessary services before, during, and after a procedure.
• Providers in the same group practice must bill as a single physician.

FAQs

Global Surgery Application Settings

• Applies in inpatient hospitals, outpatient hospitals, ambulatory surgical centers (ASC), and physicians' offices.

Classification of Global Surgery

• 0-Day Post-Operative Period: Includes endoscopies and minor procedures.
• 10-Day Post-Operative Period: Covers other minor procedures.
• 90-Day Post-Operative Period: For major procedures.

Global Surgery Indicators

• 000: Endoscopies/minor procedures with 0-day post-operative period.
• 010: Minor procedures with 10-day post-operative period.
• 090: Major surgeries with 90-day post-operative period.
• YYY: Contractor-priced codes.

Services Included in Global Surgery Payment

• Pre-operative and intra-operative services.
• Post-operative recovery visits and complications not requiring extra OR trips.
• Post-surgical pain management.

Services Excluded from Global Surgery Payment

• First evaluation for major surgeries.
• Unrelated visits or treatments during post-operative period.
• Diagnostic tests and procedures.
• Treatment for post-operative complications requiring a return to OR.

Billing Guidelines

Providers Covering Entire Global Package

• Use surgical CPT code without separate billing for services included in the global package.

Providers Covering Part of a Global Package

• Transfer of care agreements must be documented.
• Modifiers 54, 55, and 56 indicate surgical care, post-operative, and pre-operative care, respectively.

Exceptions

• Use E/M code for services not covered by modifiers 54, 55, 56.

Pre-Operative Period Billing

• E/M services leading to surgery decisions can be billed separately, using modifier 57.

Procedure Day Billing

• Use modifier 25 for significant, separately identifiable E/M services on the procedure day.

Special Cases

Multiple Surgeries

• Considered separate procedures, eligible for separate payments under certain conditions.

Co-Surgeons & Team Surgeons

• Modifier 62 and 66 for billing when multiple surgeons are involved.

Assistant-at-Surgery Services

• Payment based on a certain percentage of the surgical fee schedule. Use specific modifiers like 80, 81.

Post-Operative Period Billing

Unrelated Services

• Use modifiers 79 and 24 for unrelated procedures or services during the post-operative period.

Critical Care

• Can be billed separately if unrelated to the surgical procedure and meeting certain criteria.

Special Billing Situations

• Care provided in different jurisdictions or Health Professional Shortage Areas.

Erroneous Surgeries

• Use modifiers PA, PB, PC for surgeries on the wrong patient or body part.

Bilateral Procedures

• Use modifier 50 unless the procedure description specifies "bilateral".

Resources

• Additional resources for co-surgery and assistant-at-surgery services available in the Medicare Claims Processing Manual, Chapter 12.