Medicare Compliance & Reimbursement

Question: If a neurosurgeon calls our orthopedic surgeon to the operating room to assist, does the global period apply to the orthopedic surgeon?

Ohio Subscriber

Answer: No. The global period applies only to the primary surgeon, not to the assistant surgeon.

For future reference: According to "Global Surgery: Questions and Answers" by Palmetto GBA, the Part B Medicare carrier for Ohio, you may separately submit "services of other physicians except where the surgeon and other physician(s) agree on the transfer of care."

Services a surgeon may submit separately during the global period also include:

• initial consultation or evaluation (for major surgeries only)

• visits unrelated to the diagnosis prompting the surgery, unless the visits occur due to surgery complications (append modifier 24, Unrelated evaluation and management service by the same physician during a postoperative period; or 25, Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service)

• treatment outside of the normal surgery recovery (append modifier 24)

• diagnostic tests and procedures

• clearly distinct surgical procedures by the original surgeon during the post-op period, which are not re-operations or treatments for complications (append modifier 58, Staged or related procedure or service by the same physician during the postoperative period; or 79, Unrelated procedure or service by the same physician during the postoperative period)

• postoperative complication treatment requiring a return to the operating room (append modifier 78, Unplanned return to the operating/ procedure room by the same physician following initial procedure for a related procedure during the postoperative period)

• a more extensive procedure required if a less extensive procedure fails (append modifier 79)

• immunosuppressive therapy the surgeon provides (append modifier 24)

• critical care services (99291 and 99292) unrelated to surgery for critically injured or burned patients who require constant attention from physician (append modifier 25 [pre-op] or 24 [post-op], and submit with an ICD-9 code from 800.00-929.9 or 940.0-959.9).

Resource: You can find this list online at http://www.palmettogba.com.