Orthopedic Coding Alert

Think there really are 90 days in this period? Find out the truth The 90-day global surgical package has gotten quite a lot of press recently, and there still seems to be some confusion and misinformation out there. So let's look at what that "global package" is all about. Start by Understanding the Included Days The global period rule reads, "To determine the global period for major surgeries, carriers count the day immediately before surgery, the day of surgery and the 90 days immediately following the surgery." This does, in fact, give you 92 days. The actual 90-day countdown does not start until the day after the surgery took place, not the day of surgery. This can make tracking days tricky for the staff. Use This Tool to Simplify Calculations To simplify keeping track of global days, you can create a simple tool for your staff using a calendar. The example to the right gives the January calendar for 2008. It shows the 90-day time limit under the date. If you do the math, you-ll see it is 91 days. The day immediately preceding makes this a 92-day window. How it works: The number at the top is the January date. The numbers at the bottoms of the squares are the 91-day count out. For example, Jan. 1, 2008, would have a 91-day count out to March 31, 2008, or 1 in the top of the square translates to March 31 (3/31) in the bottom of the square. You can create these cheat sheets to see your time period at a glance. Reap Proper Reimbursement With Modifiers All of this global period information is extremely important in pre- or postoperative care. You must be very careful to compare diagnosis information with each visit in this period. If the same diagnosis is the primary reason for the visit as was the primary for the surgery, payers consider this to be in the global period, and they would deny an E/M visit under the global rule. Good news: Modifiers allow us to bill for these services during these periods, if the modifier chosen is correct for our documentation: - Modifier 54 (Surgical care only) allows for billing of only the procedure and the care that goes along with it. - Modifier 55 (Postoperative management only) allows us to follow the patient after the procedure but nothing else. - Modifier 56 (Preoperative management only) allows us to bill for the patient's care before the provider initiates the surgery or procedure. - Modifier 57 (Decision for surgery) allows for a visit the day immediately before the surgery, and payers will reimburse this E/M. Coordinate With All MDs, or Expect Hassles In today's mobile society, [...]