Neurosurgery Coding Alert

Under the concept of a global surgical package, payers bundle or include payment for services integral to a surgical procedure as a part of the procedure and not independently reportable for separate reimbursement.

For example, compensation for writing orders and conducting hospital rounds during the postoperative period is included in the payment for the surgical procedure, as are other aspects of "typical postoperative follow-up care."

But, Medicare and CPT differ in their definitions of "typical" postoperative care. What Medicare recognizes as a part of the global surgical package CPT might define as a separately reportable complication.

CPT specifies that follow-up for therapeutic surgical procedures includes "care which is usually a part of the surgical service. Complications, exacerbations, recurrence or the presence of other diseases or injuries requiring additional services should be separately reported."

Similarly, follow-up for diagnostic surgical procedures "includes only that care related to recovery from the diagnostic procedure itself. Care of the condition for which the diagnostic procedure was performed or of other concomitant conditions is not included and may be listed separately."

CMS is much more inclusive and bundles into the global package all additional medical or surgical services required of the physician during the surgery's post-operative period because of complications -- unless the complication requires a return to the operating room.