# 10060 Global Period



## joglesbee

So we have a physician that saw a patient and preformed a 10060, 3 days later he had the patient come back for a follow up.  Can the e/m be billed.  The reason I am asking this is the 10060 does have a global period, but when you look in the manual it does not relate to the CMS 100-4, 12, 40.2 billing requires for global surgeries.


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## joglesbee

anyone help me with this one?


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## FTessaBartels

*10-day global period*

10060 has a 10-day global period. We would not charge for a follow-up visit performed within this time frame.

Hope that helps.

F Tessa Bartels, CPC, CEMC


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## joglesbee

that is what I would think, but the book doesn't make it clear.  Is the 10-day global period associated with other procedures associated with the surgery.  Or is it including all post op care as well?

I know I am pushing this, but if you can bill an E/M for post op care I am definitively for it when it comes to the 10060.


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## eadun2000

joglesbee said:


> that is what I would think, but the book doesn't make it clear.  Is the 10-day global period associated with other procedures associated with the surgery.  Or is it including all post op care as well?
> 
> I know I am pushing this, but if you can bill an E/M for post op care I am definitively for it when it comes to the 10060.



Which book are you referring to?  It has a post op period of 10 days.  During those 10 days if the patient comes in for follow up and no other problem addressed, you cannot code an E&M.  What I am saying about other problems is like sore throat and physician dx tonsillitis and placed on antibiotic.  In that case, you would have to add a mod 24 as visit is in global period.  Hope this helps


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## joglesbee

I do know that, but if it is for the same dx.  It is the Procedural coding expert and in front of every code set they provide a list of the CMS publications that pertain to that specific coding set so 10040-10180.  Then it list the correct coding policy, a required physician presence, and s&i multiple procedure reduction, but does not list the global surgery package or the billing requirements for global surgeries which is a part of the next coding set 11000-11012.


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## lchrist@datfl.com

*10060 Another Question*

Hello, 

I have read the other comments on the billing during the post op treatment for the 10060.  I have another question.  Where  can I find a clear definition of what would constitute the billing out of an office visit if there complications with the cyst site?  Bear in mind that an rx. was prescribed on the initial date of treatment and the follow up visits are for complications and continued drainage & packing.    A biopsy is being billed, on the third follow up visit (due to the amount of drainage) and office visit are to be billed.  

This may be redundant...I just need material that I can print off and present.

Thank you,


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## khristinelouise

*coder*

I am having the same problem. I understand that 10060 has a 10-day global but what happens if there are complications followups for infections and repacking of wound?


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## CodingKing

khristinelouise said:


> I am having the same problem. I understand that 10060 has a 10-day global but what happens if there are complications followups for infections and repacking of wound?



My understanding is complications are bundled unless they require return to OR (I think treatment room counts but not 100% sure). Those that require return to OR would be billed with modifier 78 on the


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## mburgett

*10060 global peroid*

Our patient is similar, but with a slight twist.  Initial I&D R breast abscess done in the ER on 12/20.  Two days later she presented to our office for removal of packing, but additional work was necessary due to infection/drainage.  Is the additional work billable in this type of scenario or is this included in the E/M?


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## CodingKing

mburgett said:


> Our patient is similar, but with a slight twist. Initial I&D R breast abscess done in the ER on 12/20. Two days later she presented to our office for removal of packing, but additional work was necessary due to infection/drainage. Is the additional work billable in this type of scenario or is this included in the E/M?




The complication is global since it did not require a return to the OR. Its not uncommon to get post op infection and removal of packing would be part of the normal follow up for an I&D.


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## CatchTheWind

A treatment room does not count as a return to the operating room.  

Per CMS:  “The global surgery payment includes… all additional medical or surgical services… during the post-operative period of the surgery because of complications, which do not require additional trips to the operating room….  An OR, for this purpose, is defined as a place of service specifically equipped and staffed for the sole purpose of performing procedures. The term includes a cardiac catheterization suite, a laser suite, and an endoscopy suite. It does not include a patient’s room, a minor treatment room, a recovery room, or an intensive care unit (unless the patient’s condition was so critical there would be insufficient time for transportation to an OR).”  http://www.cms.gov/Outreach-and-Edu...oducts/downloads/GloballSurgery-ICN907166.pdf


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## ljones88

*Global surgery package*



khristinelouise said:


> I am having the same problem. I understand that 10060 has a 10-day global but what happens if there are complications followups for infections and repacking of wound?



If it is a complication that does not require a trip back to the OR, the visit is included in post op. 

From CMS directly, and OR is defined as, "...a place of service *specifically equipped and staffed for the sole purpose of performing procedures*. The term includes a cardiac catheterization suite, a laser suite, and an endoscopy suite. It does not include a patient’s room, a minor treatment room, a recovery room, or an intensive care unit (unless the patient’s condition was so critical there would be insufficient time for transportation to an OR);"....*meaning not the exam room in the physician's office*...

From the CMS manual: Medicare includes the following services in the global surgery payment when they provide them in addition to the surgery:
• Pre-operative visits after the decision is made to operate. For major procedures, this includes preoperative visits the day before the day of surgery. For minor procedures, this includes pre-operative visits the day of surgery;
• Intra-operative services that are normally a usual and necessary part of a surgical procedure; 
• All additional medical or surgical services required of the surgeon during the post-operative period of the surgery because of complications, * which do not require additional trips to the operating room;*
• Follow-up visits during the post-operative period of the surgery that are related to recovery from the surgery;
• Post-surgical pain management by the surgeon; 
• Supplies, except for those identified as exclusions; and
• Miscellaneous services, such as dressing changes, local incision care, removal of operative pack, 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.


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## acf7575

ljones88 said:


> *Global surgery package*
> 
> 
> 
> If it is a complication that does not require a trip back to the OR, the visit is included in post op.
> 
> From CMS directly, and OR is defined as, "...a place of service *specifically equipped and staffed for the sole purpose of performing procedures*. The term includes a cardiac catheterization suite, a laser suite, and an endoscopy suite. It does not include a patient’s room, a minor treatment room, a recovery room, or an intensive care unit (unless the patient’s condition was so critical there would be insufficient time for transportation to an OR);"....*meaning not the exam room in the physician's office*...
> 
> From the CMS manual: Medicare includes the following services in the global surgery payment when they provide them in addition to the surgery:
> • Pre-operative visits after the decision is made to operate. For major procedures, this includes preoperative visits the day before the day of surgery. For minor procedures, this includes pre-operative visits the day of surgery;
> • Intra-operative services that are normally a usual and necessary part of a surgical procedure;
> • All additional medical or surgical services required of the surgeon during the post-operative period of the surgery because of complications, * which do not require additional trips to the operating room;*
> • Follow-up visits during the post-operative period of the surgery that are related to recovery from the surgery;
> • Post-surgical pain management by the surgeon;
> • Supplies, except for those identified as exclusions; and
> • Miscellaneous services, such as dressing changes, local incision care, removal of operative pack, 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.



Here's my question:  
Is a re-accumulation of a hematoma a complication of an incision and drainage of a hematoma the day before?  
Patient was in the office one day and had an incision and drainage of a thigh hematoma.  The patient was back in the next day for increased pressure and pain and the area was incised and drained again.  Does this fall under the "All additional medical or surgical services required of the surgeon during the post-operative period of the surgery because of complications, which do not require additional trips to the operating room"?
10060 has a 10 day global period.  Got it, but is a re-accumulation of a hematoma a complication?  
Can the 10060 on day two be billed with a modifier 76 - repeat procedure by same provider?  A lot of the information I find is that modifier 76 is for repeat procedure the same day.  That is not stated in the modifier details.  
Is the second drainage just part of the usual care and is not billable when done in the office because the office is not considered an OR?  Would modifier -58 be applicable.  Thank you in advance for any professional AAPC comments.


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## thomas7331

acf7575 said:


> Here's my question:
> Is a re-accumulation of a hematoma a complication of an incision and drainage of a hematoma the day before?
> Patient was in the office one day and had an incision and drainage of a thigh hematoma.  The patient was back in the next day for increased pressure and pain and the area was incised and drained again.  Does this fall under the "All additional medical or surgical services required of the surgeon during the post-operative period of the surgery because of complications, which do not require additional trips to the operating room"?
> 10060 has a 10 day global period.  Got it, but is a re-accumulation of a hematoma a complication?
> Can the 10060 on day two be billed with a modifier 76 - repeat procedure by same provider?  A lot of the information I find is that modifier 76 is for repeat procedure the same day.  That is not stated in the modifier details.
> Is the second drainage just part of the usual care and is not billable when done in the office because the office is not considered an OR?  Would modifier -58 be applicable.  Thank you in advance for any professional AAPC comments.



Yes, I would consider this a complication because it is the same problem at the same site and part of the global package since it did not require a return to the operating room, so I would code this as follow-up care.  It does not meet the definition of a staged procedure, so modifier 58 would be incorrect. Modifier 76 is also incorrect  - as you've stated, that is for a repeat procedure on the same day, and this is on a different day.


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