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Ophthalmology and Optometry Coding Alert

Understand the 'Global' Before Using -78 and -79

Published on Fri Sep 19, 2003

An important step to understanding why modifiers postoperative modifiers are significant is to consider the global surgical packages during which they're used. In this case, we'll review what's included in the global periods for Medicare.
 
The Medicare-approved amount for surgical procedures includes payment for the following services related to the surgery when furnished by the physician who performs the surgery:

 

  •  Preoperative Visits. Beginning with the day before the day of surgery for major procedures and the day of surgery for minor procedures.
     
  •  Intraoperative Services. Services that are normally a usual and necessary part of a surgical procedure.
     
  •  Complications Following Surgery. All additional medical or surgical services required of the surgeon during the postoperative period of the surgery because of complications that do not require additional trips to the operating room.
     
  •  Postoperative Visits. Follow-up visits during the postoperative period of the surgery that are related to recovery from the surgery.
     
  •  Post-surgical Pain Management. By the surgeon.
     
  •  Supplies. Except for those noted in 4821.B.8.
     
  •  Miscellaneous Services. Items such as dressing changes; local incisional care; removal of operative pack; removal of cutaneous sutures and staples, lines, wires, tubes, drains, casts, and splints; insertion, irrigation and removal of urinary catheters, routine peripheral intravenous lines, nasogastric and rectal tubes; and changes and removal of tracheostomy tubes.
     
    A physician may furnish the services included in the global surgical package in any setting, for example, in hospitals, ASCs or physicians' offices. Visits to a patient in an intensive care or critical care unit are also included if made by the surgeon. However, critical care services (99291 and 99292) are payable separately in some situations.

    Services Not Included in the Global Package

    Do not include the services listed below in the payment amount for a procedure with the appropriate indicator in Field 16 of the MFSDB. See 4822.B for further guidance on identifying such services in the claims process.
     
    In some instances, providers will have to bill with the appropriate modifiers. See 4822.A for guidance on the proper use of modifiers for services performed during the global period of a procedure.

     

  •  The initial consultation or evaluation of the problem by the surgeon to determine the need for surgery.
     
  •  Services of other physicians except where the surgeon and the other physician(s) agree on the transfer of care or as specified in 4822.A.2. This agreement may be in the form of a letter or an annotation in the discharge summary, hospital record, or ASC record.
     
  •  Visits unrelated to the diagnosis for which the surgical procedure is performed, unless the visits occur due to complications of the surgery. See 4821.A.3 for further guidance on billing for complications.
     
  •  Treatment for the underlying condition or an added course of treatment that is not part of normal recovery from surgery.
     
  •  Diagnostic tests and procedures, including diagnostic radiological procedures.
     
  •  Clearly distinct surgical procedures during the postoperative period that are not reoperations or treatment for complications. (A new postoperative period begins with the subsequent procedure.) This includes procedures done in 2 or more parts for which the decision to stage the procedure is made prospectively or at the time of the first procedure.
     
  •  Treatment for postoperative complications that requires a return trip to the operating room (OR). CMS defines an OR for  as a place of service specifically equipped and staffed for the sole purpose of performing procedures, including a cardiac catheterization suite, a laser suite, and an endoscopy suite.
     
    If a less extensive procedure fails, and a more extensive one is required, the second procedure is separately payable.

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