Orthopedic Coding Alert

Question: If a neurosurgeon calls our orthopedic surgeon to the OR to assist, does the global period apply to the orthopedic surgeon?

Ohio Subscriber

Answer: No. The global period applies only to the primary surgeon, not to the assistant surgeon.

For future reference: According to "Global Surgery: Questions and Answers" by Palmetto GBA, the Part B Medicare carrier for Ohio, you may separately submit "services of other physicians except where the surgeon and other physician(s) agree on the transfer of care."

Services a surgeon may submit separately during the global period also include:

- initial consultation or evaluation (for major surgeries only)

- visits unrelated to the diagnosis prompting the surgery, unless the visits occur due to surgery complications (append modifier 24, Unrelated evaluation and management service by the same physician during a postoperative period, or 25, Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service)

- treatment outside of the normal surgery recovery (append modifier 24)

- diagnostic tests and procedures

- clearly distinct surgical procedures by the original surgeon during the post-op period, which are not re-operations or treatments for complications (append modifier 58, Staged or related procedure or service by the same physician during the postoperative period, or 79, Unrelated procedure or service by the same physician during the postoperative period)

- postoperative complication treatment requiring a return to the operating room (append modifier 78, Unplanned return to the operating/procedure room by the same physician following initial procedure for a related procedure during the postoperative period)

- a more extensive procedure required if a less extensive procedure fails (append modifier 79)

- immunosuppressive therapy the surgeon provides (append modifier 24)

- critical care services (99291 and 99292) unrelated to surgery for critically injured or burned patients who require constant attention from physician (append modifier 25 [pre-op] or 24 [post-op], and submit with an ICD-9 code from 800.00-929.9 or 940.0-959.9).

Resource: You can find this list online at www.palmettogba.com. Under "Quick Links," choose "OH Part B Carriers." Under "Articles," choose "Surgery," and then click on "Global Surgery: Questions & Answers."