Wiki Relation between CMS readmission and global surgical period

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Mmschoo

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Does anyone have a good resource for understanding the relationship between readmission for complications and the global surgical period? For example, if a patient had a procedure with a 090 global period and developed a bloodstream infection (R78.81) on day 30 that could be documented as directly related to the procedure: does that change the DRG to a DRG with CC (assuming no exclusion)? would it the cost of treating the CC be considered part of the global period and not paid separately (patient is readmitted to hospital for medical but no O.R. procedure needed)? thank you.
 
Mmschoo said:
Does anyone have a good resource for understanding the relationship between readmission for complications and the global surgical period? For example, if a patient had a procedure with a 090 global period and developed a bloodstream infection (R78.81) on day 30 that could be documented as directly related to the procedure: does that change the DRG to a DRG with CC (assuming no exclusion)? would it the cost of treating the CC be considered part of the global period and not paid separately (patient is readmitted to hospital for medical but no O.R. procedure needed)? thank you.
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The Global Surgical Package relates to physician reimbursement. DRG is for inpatient facility reimbursement. The physician's global period for surgery isn't going to affect the inpatient facility's DRG assignment.

I'm not even sure if that would be feasible - an inpatient facility would use ICD-10-PCS codes for procedures. The physician's global surgical package would be defined by CPT codes.

Some payers have readmission policies that will combine 2 claims if a patient is readmitted shortly after discharge, but that's not based on global surgery. It's based on a payer's hospital readmission policy.

Here's an MLN booklet where you can review Global Surgery as it pertains to physician reimbursement. Page 6 specifically will tell you what is and isn't included in the global package for the physician: https://www.cms.gov/files/document/mln907166-global-surgery-booklet.pdf
 
sls314 said:
The Global Surgical Package relates to physician reimbursement. DRG is for inpatient facility reimbursement. The physician's global period for surgery isn't going to affect the inpatient facility's DRG assignment.

I'm not even sure if that would be feasible - an inpatient facility would use ICD-10-PCS codes for procedures. The physician's global surgical package would be defined by CPT codes.

Some payers have readmission policies that will combine 2 claims if a patient is readmitted shortly after discharge, but that's not based on global surgery. It's based on a payer's hospital readmission policy.

Here's an MLN booklet where you can review Global Surgery as it pertains to physician reimbursement. Page 6 specifically will tell you what is and isn't included in the global package for the physician: https://www.cms.gov/files/document/mln907166-global-surgery-booklet.pdf
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Thank you - that makes sense. I saw the global surgery booklet and it was the part where the procedure was inpatient that i guess started me over thinking. So if someone was doing a hernia repair (IDK if this can be done outpatient but just for example...) it would be 39540 if outpatient surgery and potentially 0BQTOZZ if inpatient? Complications treated by the surgeon outpatient/would be included as post-operative care, but a readmission would would follow the hospitals rules for readmission on the DRG?
I really appreciate you clarifying the link between the 2.
 
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