Use Modifiers for Payment of Services During Global Periods
Published on Tue Aug 01, 2000
Coders supporting interventional radiologists may help their physicians avoid forfeiting a lot of reimbursement by gaining a comprehensive understanding of how global surgical packages work. Although some interventional services carry no global period, to code properly, coders must recognize the role modifiers play when used correctly with interventional codes that carry a 10- or 90-day global surgical period.
Many physicians and coders mistakenly believe they cant bill for any procedure during the global period, even if it is totally unrelated to the original interventional service or caused by extraordinary circumstances, says Gary Burns, MBA, RHIA, principal of Medical Asset Management Inc., a national training, contract coding and auditing firm in Atlanta. This simply is not the case. There are occasions when it is appropriate to bill for services provided during the global period and they most likely will be paid if they have been reported with the correct modifier.
Although modifiers are useful for procedures with 10-day global periods, they take on even greater significance when the service in question has a 90-day global period, he notes. Because the longer time period creates more exposure in those services with a 90-day global, there is a greater chance another billable service (either related or unrelated) may be required.
Global Periods Standardize Reimbursement
The global system was established by the Health Care Financing Administration (HCFA) to ensure standardized reimbursement for the same services across all jurisdictions, Burns explains. CPT guideline s note that global periods include the procedure and services directly related to them (e.g., sedation), as well as normal, uncomplicated follow-up care.
The Medicare Physician Fee Schedule Data Base provides the periods of time that apply to each interventional procedure, which regulate codes with entries of 000, 010, 090, YYY and XXX. Codes carrying 000 or 010 (zero- or 10-day global periods) most often are minor procedures or endoscopies. Codes with a 090 (or 90-day period) are major procedures, while codes with a YYY are carrier-priced codes for which the payer determines the global period. XXX-designated codes do not fall within the global period policy.
Note: Although it would seem that 000 and XXX global periods are the same both appear to have no days that would preclude billing other services there is a subtle difference. Procedures that carry a zero-day global period include a global period such that certain services provided on the same date of service will not be covered. This concept is covered in discussions of bundled services and fragmentation, as opposed to global periods. Only services with a global period of XXX are truly free of [...]
