Practice Management Alert

Question: What's the difference between an "XXX" global period and a "000" global period?


Oregon Subscriber


Answer: There is a distinct difference between these two global periods. The classification XXX (Global surgical rules do not apply) means the service is truly free of global surgical bundling issues. You can separately report services, such as E/M visits, that you perform on the same date as a surgical procedure with an XXX global period.

The 000 classification means the procedure adheres to bundling rules only on the date of the service. Medicare will therefore bundle all services that you perform on the surgery date into codes with this 000 global period.

Example: Puncture aspiration of a breast cyst (19000) includes a 000 global period. So if you perform an E/M service on the same date as the aspiration, Medicare will bundle the E/M into 19000 - unless the physician provides the E/M service for a significant, unrelated problem and appends modifier -25 (Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service) to the E/M code.

By contrast, placement of a naso- or oro-gastric tube (43752, Naso- or oro-gastric tube placement, requiring physician's skill ...) has an XXX global period. So if the physician provides a related E/M visit on the same day as this service, Medicare should not bundle the E/M code into 43752.

Best practice: You should still append modifier -25 to the E/M code if you report it on the same day as a procedure with an XXX global period. Modifier -25, along with physician documentation, proves the E/M service was "significant" and therefore more in-depth than the typical E/M component the procedure code already includes.

The answers to the Reader Questions were provided and/or reviewed by Catherine Brink, CMM, CPC, president of HealthCare Resource Management Inc. in Spring Lake, N.J.