# Global Periods-clear understanding



## msmurdaugh

Hello,
I need a clear understanding on the MOH's 90 day rule for the Global Periods and billing for office visits within that period for complications and non complications.

Thanks


----------



## rad1965

Let's see if this helps you a little. 

There are two types of services not included in surgical package codes. These are billed seperately and are reimbursed in addition to the surgical package. 

Complications or recurrences that arise after therapeutic surgical procedures.

Care for the condition for which a diagnostic surgical procedure is performed. Routine follow up care included in the code refers only to care related to recovery from the diagnostic procedure itself, not the condition


----------



## mitchellde

Not necessarily so.  The CPT book has their version of the surgical global... and then there is Medicare's version, and like it or not most every carrier follows Medicare.  And Medicare considers all complications that do not require a return to the OR a part of the post op global.  Here is an excerpt from a Medscape article:
 Medicare's view

As is common, Medicare's rules differ slightly from that of CPT. Section 4821 of the Medicare Carriers Manual (available online at cms.hhs.gov/manuals/14_car/3b4820.asp#_1_2) provides a definition of Medicare's global surgical package. Many other payers use this as a model. From a Medicare perspective, surgical procedures include the following services when furnished by the physician who performs the surgery:
The decision for surgery is not part of the surgical package and should be separately coded using an E/M code.

    * Preoperative visits after the decision is made to operate beginning with the day before the day of surgery for major procedures and the day of surgery for minor procedures;
    * Intraoperative services that are a usual and necessary part of a surgical procedure;
    * All additional medical or surgical services required of the physician during the postoperative period of the surgery because of complications not requiring additional trips to the operating room;
    * Follow-up visits during the postoperative period of the surgery that are related to recovery from the surgery;
    * Postsurgical pain management;
    * Certain supplies;
    * Miscellaneous services (e.g., dressing changes; local incision care; removal of operative packs; removal of cutaneous sutures and staples, lines, wires, tubes, drains, casts and splints; insertion, irrigation and removal of urinary catheters, routine peripheral intravenous lines, nasogastric and rectal tubes; and changes and removal of tracheostomy tubes).

Note a couple of distinctions between the Medicare and CPT package: First, unlike CPT, Medicare includes in the surgical package treatment of complications that do not require additional trips to the operating room. Second, unlike CPT, the postoperative part of Medicare's global period is not open-ended. Medicare assigns postoperative global periods of 90 days to major surgeries and either zero or 10 days to minor surgeries and endoscopies. Any services beyond the Medicare postoperative global period, even if related to the procedure, are separately reportable. If you have any questions about the length of the postoperative global period assigned to a given code, you can find it in the Medicare Physician Fee Schedule database, available online at cms.hhs.gov/physicians/mpfsapp/step0.asp.


----------



## msmurdaugh

*Copay on Gloabal Periods*

Thanks Guys,
This information was very helpful and will help me inform my schedulers in regards to scheduling and informing patients about charges in regards to procedures.

One last question...Will a copay apply during a global visit or is there just no charge at all for the 0-10 day for minor surgery and the 90 day global periods?


----------



## mitchellde

no charge


----------



## jvalntine

*how to find global period for cpt codes*

Does anyone know the cms link to find global days for cpt codes?
jv


----------

