Neurosurgery Coding Alert

Question: How can I find the length of postoperative global periods for various procedures the surgeon performs?

Maine Subscriber Answer: CMS publishes global surgical periods for all CPT codes each fall in the Federal Register, but the most convenient and accessible place to find this information is in the Physician Fee Schedule database.

You can locate the global period information in column "O" (labeled "GLOBAL DAYS") of the Fee Schedule database. Major surgical procedures (including common neurosurgery procedures such as laminectomy, arthrodesis, and craniotomy) include a 90-day global period. Lesser surgical procedures may include a 10-day (for example, 61888, Revision or removal of cranial neurostimulator pulse generator or receiver) or 0-day (for example, 61000, Subdural tap through fontanelle, or suture, infant, unilateral or bilateral; initial) global period.

CMS also specifies global periods of "XXX," "YYY" and "ZZZ." An XXX designation means the global-period concept does not apply to that particular code. An example of such a service is 62367 (Electronic analysis of programmable, implanted pump for intrathecal or epidural drug infusion [including evaluation of reservoir status, alarm status, drug prescription status]; without reprogramming).

The "YYY" global period applies only to unlisted- procedure codes (such as 22899, Unlisted procedure, spine) and indicates that the individual payer is free to determine a global period for the procedure.

The ZZZ designation denotes an add-on procedure for which the global period is included in the primary procedure. For instance, CMS "bundles" the global period for add-on procedure +63048 (Laminectomy, facetectomy and foraminotomy [unilateral or bilateral with decompression of spinal cord, cauda equina and/or nerve root(s), (e.g., spinal or lateral recess stenosis)], single vertebral segment; each additional segment, cervical, thoracic or lumbar [list separately in addition to code for primary procedure]) to the 90-day global period of the primary procedure code 63045 (... cervical).

CMS updates the fee schedule yearly, and you must always be sure to work from the most current file. You may download the information free of charge from the CMS Web site (www.cms.gov). After downloading the file, you may choose to view the fee schedule database in a variety of formats, including as a text (.txt) file or an easy-to-navigate Excel file.