Gastroenterology Coding Alert

Question: I'm new to coding, and I hear "global surgical package" a lot. What does it mean for gastroenterology?


Tennessee Subscriber

Answer: The "global surgical package" describes all services integral to a procedure as described by CPT. For any procedure, payment includes the performance of these "packaged" services.

The AMA, through CPT guidelines, includes in the global package:

• Local infiltration, metacarpal/metatarsal/digital block or topical anesthesia
• Subsequent to the decision for surgery, one related E/M encounter on the date immediately prior to or on the date of the procedure (including history and physical)
• Immediate postoperative care, including dictating operative notes, talking with the family and other physicians
• Writing orders
• Administering and monitoring of intravenous sedatives and analgesics
• Evaluating the patient in the postanesthesia recovery area
• Typical postoperative follow-up care.

Example: Your gastroenterologist performs a diagnostic colonoscopy and determines that a polyp is causing the patient's rectal bleeding. He removes the polyps with hot biopsy forceps to cauterize the polyp site and stop the bleeding.

Solution: You report 45384 (Colonoscopy, flexible, proximal to splenic flexure; with removal of tumor[s], polyp[s], or other lesion[s] by hot biopsy forceps or bipolar cautery). Because 45384 has a zero-day global period, you shouldn't bill for any physician services related to the colonoscopy that the gastroenterologist provides on the day of the procedure.

On the other hand, if the gastroenterologist is called in to consult on a patient with rectal bleeding, and after examining the patient decides to schedule a colonoscopy for that afternoon, you can report the consult with modifier 25 (Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service) attached. The physician had to see and examine the patient to determine that this procedure was necessary.