Ophthalmology and Optometry Coding Alert

Tip: Even ‘XXX’ globals will impact your income.

Global periods are often thought of as those all-inclusive reimbursement mechanisms that impact serious surgeries like corneal transplants and retinal repairs, but the reality is that even minor procedures have global periods. How you report your services during these periods can dramatically affect your reimbursement, so check out the following quick primer to ensure that you’re reporting these services correctly.

Check the Fee Schedule, Then Count Your Days

You should get to know the following types of global periods, which you can find in the Medicare Physician Fee Schedule:

000 —  This period indicates that related preoperative and postoperative care on the day of the procedure are included in the fee for the procedure itself. Any related evaluation and management work done on the same day as a procedure with this global is included.

Example: Under Medicare guidelines, 67820 (Correction of trichiasis; epilation, by forceps only) has a global period of 0 days. Therefore, any related E/M procedures performed on the same day of service are typically not separately reportable.

010 — This period indicates that Medicare includes 10 days of postoperative care in the payment. Any E/M services you perform on the day of the procedure and during the ten-day global period are not typically reimbursed but may be paid under appropriate circumstances and documentation to support medical necessity.

Example: You’ll find a 010 global period for 67825 (Correction of trichiasis; epilation by other than forceps [eg, by electrosurgery, cryotherapy, laser surgery]).

Manage 25 With Minor Procedures

Procedures with global periods of 10 days are generally considered “minor procedures.” Because of this designation, Medicare and private payers don’t pay separately for the E/Ms performed on the same day and consider a small history, exam, and MDM included in the fee for minor procedure. In order to get paid separately for a separately identifiable and medically necessary E/M service performed on the same day as a minor procedure, you have to ensure that the E/M was documented as separate and significantly identifiable, in which case you can append modifier 25 (Significant, separately identifiable evaluation and management service by the same physician or other qualified health care professional on the same day of the procedure or other service).

Rely On 57 For E/Ms With Major Procedures

090 — Procedures with 90-day global periods have one day of preoperative care and 90 days of postoperative care included in the fee for the initial procedure.

Codes with a 90-day global period are considered major surgeries. If the E/M that prompts the decision for surgery is performed on the same day or the day before an unscheduled surgery, you should append modifier 57 (Decision for surgery) to receive separate payment for the E/M work.

Example: A patient has a detached retina, and the ophthalmologist presents to the hospital to fix it the same day it is diagnosed. The surgeon reports 67108 (Repair of retinal detachment; with vitrectomy, any method, including, when performed, air or gas tamponade, focal endolaser photocoagulation, cryotherapy, drainage of subretinal fluid, scleral buckling, and/or removal of lens by same technique), which has a 90-day global period, so it includes all services provided the day of and day before the procedure. But because this was an unscheduled surgery, the surgeon may append 57, indicating that the E/M was the decision-for-surgery service and therefore separately billable.

Avoid Pigeon-Holing Groups

The remaining four global period categories do not have specific time periods for postoperative care attached to them.

MMM —  This period describes a service furnished in uncomplicated maternity cases including antepartum care, vaginal delivery and postpartum care, and is not relevant to eye care providers.

XXX — Codes assigned “XXX” are not subject to the global period concept. Evaluation and management services and other services performed may be reported separately on the same day as this code. For example, 92310 (Prescription of optical and physical characteristics of and fitting of contact lens, with medical supervision of adaptation; corneal lens, both eyes, except for aphakia) has an XXX global period.

YYY — This designation means that individual carriers determine the global period. YYY usually applies to unlisted procedures, and the global period a carrier assigns will depend on the type of unlisted service. For instance, unlisted codes 68399 (Unlisted procedure, conjunctiva) and 67999 (Unlisted procedure, eyelids) carry YYY global periods.

ZZZ — This global period designation means the procedure is related to another primary procedure and falls within the global period of the other service. Only the additional intra-service work to perform this service is included in the work RVU. This global period typically applies to add-on codes, including +66990 (Use of ophthalmic endoscope [List separately in addition to code for primary procedure]) and +67225 (Destruction of localized lesion of choroid [eg, choroidal neovascularization]; photodynamic therapy, second eye, at single session [List separately in addition to code for primary eye treatment]).

Medicare lists the global periods in its Fee Schedule, but you should ask private carriers for their global periods in writing, because they may differ from Medicare’s coverage.