Orthopedic Coding Alert

Count on preoperative, intraoperative, and postoperative services and care.

Below are some important and routine services that you will typically consider part of global surgical package:

Preoperative visits: You include preoperative visits in global period when these visits are after your provider has made a decision to operate. This typically implies the day before the day of surgery for major procedures and the day of surgery for minor procedures. This is true unless the decision to operate was made the day before the surgery, which occurs fairly often for urgent cases, such as fracture ORIF;

Intraoperative services: The intra-operative services that you will count as part of global surgical package are those that are considered usual and necessary part of a surgical procedure;

Postoperative visits: You include follow-up visits that the patient is asked to make during the postoperative period to monitor and support recovery from the surgery; Complications following surgery: You include any additional medical or surgical services that necessitate your provider performs in the postoperative period because of complications that do not require additional trips to the operating room. Note: This is a Medicare National Correct Coding Initiative (CCI) rule. Treatment of complications in the office setting may be reportable to non-Medicare payers;

Postsurgical pain management: Make note that any postsurgical pain management that your surgeon does is inclusive in the global surgical package. Supplies and miscellaneous services: Include all supplies in the global surgical package except for those identified as exclusions. Remember to count on some routine services like dressing changes; removal of any items like sutures, staples, tubes, drains, wires, casts and splints; care of incision(s); insertion, irrigation, and removal of intravenous lines, and urinary catheters; and other similar services.

Resource note: These services included in the global surgical package are defined in Section 40.1 of the Claims Processing Manual (Pub. 100–04, Chapter 12 Physician/Nonphysician Practitioners).