# start date for global period



## hlmcintyre (Apr 1, 2010)

Patient comes in for follow-up for an ongoing problem.  Surgery is recommended and the patient agrees, but doesn't want the surgery scheduled until later - as much as 2-3 months.  When would the global period start?  Hospital rules state the H&P/consent has to be signed and dated no more than 30 days prior to surgery.  Can the MD have the patient come in prior to the actual surgery date for the H&P and consent and bill an E/M code, even though technically the decision for surgery has been made?


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## FTessaBartels (Apr 1, 2010)

*Well ...*

Normally I'm the person singing the song that once you've made the decision for surgery you don't charge any more E/M services for just doing the H&P.

However ... if there are several months in between decision and surgery, especially when this is done at patient request, then I could see that it would be reasonable to require another evaluation to make sure the surgical plan was still appropriate and the patient was still a good candidate for surgery.   

NOTE ... my rationale has nothing to do with the hospital's requirement for an H&P w/in 30 days of admission.  It has everything to do with the *medical necessity *of an E/M. 

Hope that helps.

F Tessa Bartels, CPC, CEMC


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## hlmcintyre (Apr 1, 2010)

*okay, but....*

Thanks, Tessa for your quick response.  I understand the fact that you can't bring a patient back in for an H&P if the decision for surgery has been made, but what is the actual start date of the global period?  Does the 90 day global period start when the decision for surgery is made?  Or does it start the day surgery is performed?  How would you adjust your system to indicate the correct global period if it starts prior to the actual date of surgery?  Aren't the insurance companies basing the global period on the surgical date?  If the global period actually starts with the decision for surgery, but there isn't a code for an H&P, how would you indicate the actual start date of the global period?

Hope this isn't too confused, but I sure am confused at this point!  Thanks for any light you can shed on this.


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## FTessaBartels (Apr 1, 2010)

*Global Period*

The global period for a major surgery (90 day global), begins on the day of surgery and continues for 90 days post-op.

HOWEVER ... There is a rule about an E/M on the same date or day prior to a major surgery.  Since all hospitals require some sort of H&P, the only time you can charge for that E/M service if it is the "decision for surgery."

EVERY visit must be medically necessary. Having someone come in just to fulfill an administrative requirement (H&P within 30 days) does not meet the definition of medical necessity, so you shouldn't charge for it. (You are actually already being paid for this service as part of the reimbursement for the major surgical procedure.)

Hope that helps.

F Tessa Bartels, CPC, CEMC


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