General Surgery Coding Alert

Question: What's the difference between an "XXX" global period and a "000" global period?

Indiana Subscriber

Answer: Although both XXX and 000 global periods appear free of global bundling issues, you should know that there is a distinct difference between the two.
 
The classification XXX (Global surgical rules do not apply) means that the service is truly free of global surgical bundling issues, and you can separately report services that you perform on the same date as the surgical procedure (such as E/M services).
 
The 000 indicator applies to the date of the procedure only. Medicare will therefore bundle all surgical services that you perform on the surgery date into codes with this indicator.
 
For instance, puncture aspiration of a breast cyst (19000) includes a 000 global period. This means that if you perform an E/M service on the same date as the aspiration, Medicare will bundle the E/M into payment for 19000 unless, of course, the physician provides the E/M service for a significant, unrelated problem. In this case, you may report the E/M (for example, 99213) separately and append modifier -25, Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service.
 
If, however, the surgeon places a naso- or oro-gastric tube (43752, Naso- or oro-gastric tube placement, necessitating physician's skill), these procedures include an XXX global period. If the physician provides a related consult on the same day he or she places such a tube, Medicare should not attempt to bundle consult payment into 43752 because the XXX global period applies.
 
But in practice, you should still bill a consult with modifier -25 appended if you are also reporting 43752 or any other procedure with an XXX global period. Modifier -25, along with the physician's documentation, proves that the E/M service was "significant" and therefore more in-depth than the typical E/M component included as part of the testing itself.