Medicare Compliance & Reimbursement

Understand the specifications for 10-day versus 90-day.

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 on day of 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 urologist sees a patient in the hospital for a consultation and decides he needs to perform a transurethral resection of the prostate (TURP), 52601 (Transurethral electrosurgical resection of prostate, including control of postoperative bleeding, complete [vasectomy, meatotomy, cystourethroscopy, urethral calibration and/or dilation, and internal urethrotomy are included]), which carries a 90-day global period. If the TURP is performed that same day or the following day, you would modify the E/M hospital visit with modifier 57 to ensure payment of the E/M service on the same day.

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.