General Surgery Coding Alert

Question: When I am consulted in the hospital about a patient and I recommend surgery the next day, does the consultation fall in the 90-day global period because it was done the day before the surgery?

California Subscriber

Answer: No. Services on the day of a major surgery or on the day before a major surgery that resulted in the initial decision to perform surgery are not included in the global surgery period and may be billed separately, says Tammy Chidester, CPC, billing supervisor with Upshur Medical Management Services, a multi-specialty coding and billing service in Buckannon, W.Va. Whatever appropriate evaluation and management (E/M) code that is used should be appended with modifier -57 (decision for surgery), which indicates that the decision to perform the procedure resulted from this E/M, which therefore should be paid separately.

The global period does include many services, such as:

Preoperative visits after the decision for surgery, beginning with the day before the day of major surgery and the day of surgery for minor surgery.

Intraoperative services that are normally a usual and necessary part of a surgical procedure, routine complications, or complications after surgery that do not require a return trip to the operating room.

Postoperative visits related to the surgery.

Postoperative pain management.

Miscellaneous services or supplies.

A history and physical exam would be considered a usual and necessary part of a surgical procedure and would not be coded separately.

If the patient is not going directly to surgery or having surgery the following day, you may bill whatever level of E/M service you provided.