Oral Surgery Coding & Reimbursement Alert

Question: Many of our biopsy procedures have a 10-day global period. What is the purpose of this global period? Is it necessary to delay definitive surgical procedures until the 11th day following a biopsy to treat a person with cancer? Specific examples of this would include biopsies of the oral cavity, oropharynx and tongue.

New York Subscriber

Answer: You are correct that the biopsy procedures mentioned have a 10-day global period. As you have mentioned, some of the examples of these include:

• 40808--Biopsy, vestibule of mouth

• 41100--Biopsy of tongue; anterior two-thirds

• 41105–Biopsy of tongue; posterior one-third

• 41108–Biopsy of floor of mouth

• 42800–Biopsy; oropharynx.
  

But, this does not mean that your surgeon should delay any procedure to treat a patient, or that if the procedures are carried out during the global period your oral surgeon will not get paid.

However, in order to receive reimbursement for the procedure performed during the 10-day global period after the biopsy, you will need to report the procedure performed with an appropriate modifier. The modifier that you will need to use in such an instance where your surgeon performs a procedure during the global period following the biopsy is modifier 58 (Staged or related procedure or service by the same physician or other qualified health care professional during the postoperative period). 

For instance, your oral surgeon performs a biopsy of tongue (41100). The pathology report, which returns a few days later, indicates the presence of a malignant tumor. Your surgeon then decides to excise the tumor (41113,Excision of lesion of tongue with closure; posterior one-third). When your report the excision, you will have to append the modifier 58 to 41113 to indicate that your surgeon performed a staged procedure that should not be included in the 10-day global period for 41100.

In this case, the surgical excision of the tumor was not preplanned (although it is still considered staged) because had the biopsy returned negative, your surgeon might not have performed the excision procedure immediately. You will need to append modifier 58 whether or not the procedure is preplanned.