ED Coding and Reimbursement Alert

The CMS Global Surgery Booklet is a great starting point to investigate the nuances of global periods. Take a look at these two agency guidelines on 10-day and 90-day global surgery packages that may factor into your modifier 57 (Decision for surgery) coding smarts.

1. See CMS clarifications on 10-day global surgery packages:

• “No preoperative period,
• “Visit ondayof the procedure is generally not payable as a separate service,
• “Total global period is 11 days. Count the day of the surgery and the 10 days immediately following the day of the surgery.”

Example: A patient complains of pain in her foot ever since walking on a dock at the beach. The physician examines her foot and finds a splinter in the subcutaneous tissue. You’ll report the splinter removal with 28190 (Removal of foreign body, foot; subcutaneous), which carries 10 global days.

2. Consider the following CMS specifications to classify 90-day global period procedures:

• “One day preoperative included, 
• “Day of the procedure is generally not payable as a separate service,
• “Total global period is 92 days. Count 1 day before the day of the surgery, the day of surgery, and the 90 days immediately following the day of surgery.”

Example: A patient reports to the ED complaining of severe shoulder pain. During a level-four E/M, the ED physician determines the patient has a dislocated shoulder. The physician performs a shoulder reduction. On the claim, you would report 99284-57 (- a detailed history; a detailed examination; and medical decision making of moderate complexity ...) and 23650 (Closed treatment of shoulder dislocation, with manipulation; without anesthesia). If the ED physician is not providing follow-up care for the patient, remember to append modifier 54 (Surgical care only) to 23650.

Remember: CMS classifies “major” surgeries with a 90-day global period designation and “minor” surgeries with a 10-day global period designation.

For a closer look at the MLN Global Surgery Booklet visit www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/downloads/GloballSurgery-ICN907166.pdf.