Cardiology Coding Alert

Question: I see a lot of discussion about "global periods," but I cannot find anything in CPT that defines the global period for any particular procedure. Where can I find this information? Also, I heard that the global period applies to everyone in our group. Is that true?


Michigan Subscriber

Answer: You can find global-period information in the Medicare Physician Fee Schedule Database, available as a free download on the Medicare Web site at www.cms.hhs.gov/PhysicianFeeSched/.

Good advice: Not only do you need to know a procedure's global period, you need to know who is bound to that global period. Many physicians, such as cardiologists and cardiothoracic surgeons, don't realize that the global period applies to every doctor in the same group who reports under the same tax identification number.

Example 1: A surgeon performs a CABG. The cardiologists aren't bound by the global periods because they're not usually under the same tax identification number. So the cardiologists can report their services without a modifier.

Example 2: An electrophysiologist inserts an implantable cardioverter defibrillator (ICD) or pacemaker. If the general cardiologist, who manages the patient's hypertension, sees the patient during the global, you'll need modifier 24 (Unrelated evaluation and management service by the same physician during a postoperative period) attached to the office visit code (99211-99215) because the electrophysiologist and general cardiologist will usually report under the same tax ID.

Using modifier 24 will illustrate that the E/M service during which the cardiologist managed the patient's hypertension was unrelated to the defibrillator implantation surgery.