Global Surgical Package Overview

Overview

This lecture explains the global surgical package in procedural coding, detailing included services, global periods, and essential modifiers for accurate CPT code reporting and reimbursement.

The Global Surgical Package

• The global surgical package bundles preoperative, intraoperative, and postoperative care under one code for a single payment.
• Services included in the package are listed in the CPT manual, surgery guidelines section.
• Length and included services in the global period vary by payer—always check payer-specific rules.
• Major surgeries: global period is 92 days (one day pre-op, day of surgery, 90 days post-op).
• Minor surgeries: global period is 0 or 10 days (day of procedure plus 0 or 10 days post-op).

Determining and Reporting Global Days

• Global days for procedures can be found in the CMS RVU file.
• No days listed in global column means: MMM (maternity), XXX (not applicable), YYY (unlisted), ZZZ (add-on code).

Key Modifiers for the Global Package

• Modifier 54: Surgical care only.
• Modifier 55: Postoperative management only.
• Modifier 56: Preoperative management only.
• Modifier 24: Unrelated E/M service during post-op period by same provider.
• Modifier 25: Significant, separately identifiable E/M service on same day as minor procedure.
• Modifier 57: Decision for major surgery made during E/M visit.

Additional Surgical Modifiers

• Modifier 58: Staged, planned, or more extensive procedure during post-op period.
• Modifier 78: Unplanned return to OR for related procedure/complication during post-op period.
• Modifier 79: Unrelated procedure during post-op period.

Common Procedural Modifiers

• Modifier 22: Increased procedural services (extra work—requires documentation).
• Modifier 50: Bilateral procedure (same procedure both sides—check code description and payer policy).
• Modifier 51: Multiple procedures, same session—append to additional procedures.
• Modifier 59: Distinct procedural service (separate site, lesion, injury, etc.).
• X modifiers—XE (Separate Encounter), XS (Separate Structure), XP (Separate Practitioner), XU (Unusual Non-Overlapping Service).

Other Important Modifiers

• Modifier 63: Procedure on infant <4 kg—check CPT Appendix F for exemptions.
• Modifier 76: Repeat procedure by same provider.
• Modifier 77: Repeat procedure by different provider.
• Modifier 62: Two primary surgeons (co-surgeons).
• Modifier 66: Team surgery.
• Modifiers 80, 81, 82: Assistant surgeons (entire, minimal, no resident available).

Ancillary & Laboratory Modifiers

• Modifier 26: Professional component only.
• Modifier TC: Technical component only.
• Modifier 90: Lab test referred to outside lab.
• Modifier 91: Repeat clinical diagnostic lab test (not confirmatory).
• Modifier 92: Alternative lab platform testing (portable/kit-based).

Anesthesia Modifiers

• Modifier 23: Unusual anesthesia.
• Modifier 47: Surgeon-administered anesthesia.
• P1–P6: Physical status indicators (P1—healthy to P6—brain dead for organ donation).

Key Terms & Definitions

• Global Surgical Package — Bundled payment covering all care related to a surgical procedure.
• Modifier — A two-digit add-on to a CPT code that explains special circumstances affecting code definition or reimbursement.
• E/M Service — Evaluation and Management service, typically for assessing and managing patient care.

Action Items / Next Steps

• Highlight global package services and standard global periods in your CPT manual.
• Review the surgery guidelines and parenthetical instructions in the CPT codebook.
• Practice identifying which modifiers apply in different scenarios.
• Check payer-specific policies on modifier usage, especially for modifiers 50 and 59.
• Review codes exempt from modifier 63 in Appendix F.