Ophthalmology and Optometry Coding Alert

Question: What's the difference between an "XXX" global period and a "000" global period?

Indiana Subscriber

Answer: Although both XXX and 000 global periods appear free of global bundling issues, you should know that there is a distinct difference between the two.

The classification XXX (Global surgical rules do not apply) means that the service is truly free of global surgical bundling issues, and you can separately report services that the ophthalmologist performs on the same date as the surgical procedure (such as E/M services).

The 000 indicator applies to the date of the procedure only. Medicare will therefore bundle all surgical services that the ophthalmologist performs on the surgery date into codes with this indicator.

Example 1: Corneal smear (65430) includes a 000 global period. This means that if the ophthalmologist performs an E/M service on the same date as the smear, Medicare will bundle the E/M into payment for 65430 --unless, of course, the E/M service is considered necessary to evaluate the current problem or a different problem if significant and separately identifiable documentation is present. In this case, you may report the E/M (for example, 99213) separately and append modifier 25 (Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service).

Example 2: If, however, the ophthalmologist fits a patient for contact lenses, this procedure (92070) includes an XXX global period. If he provides a related consult on the same day that he fits the contacts, Medicare should not attempt to bundle consult payment into 92070 because the XXX global period applies.

Advice for You Be the Coder and Reader Questions provided by Maggie M. Mac, CPC, CEMC, CHC, CMM, ICCE, director, Best Practices-Network Operations at Mount Sinai Hospital in New York City.