Urology Coding Alert

Contacting individual payers before submitting surgical package claims (50010-55865, except 51725-51797 for urodynamics) will help you to sort out the appropriate CPT or Medicare definition to use for a global period, advises Mark Cendron, MD, associate professor of surgery for Urology and Pediatrics at Dartmouth Hitchcock Medical Center, Lebanon, N.H. It is particularly important that you resolve early on what your payers guidelines are on the lengths of post-operative services, because CPT and Medicare definitions for surgical packages differ markedly, Cendron adds.

In addition, third party payers may have their own guidelines regarding what constitutes an appropriate length of time for the global period, or follow-up for surgical services and procedures. Indeed, the differences in the global period can range from 21 days to as much as 90 days of follow up for the same procedure.

Within the Global Period

If the post-operative procedure does not fall within the global period, then the urologist is entitled to independently claim reimbursement under both CPT and Medicare guidelines. If the procedure occurs within the global period, then the office procedure is considered a normal complication of the initial surgery. For instance, a patient returns to see the urologist with a wound infectioncomplications from a cystotomy (51520)within the global period and is treated during the office visit. If the exam is part of the surgical global package and the procedure is considered a normal complication of surgery, then the service is not billable.

CPT, for example, says the surgical package includes only the following elements:

The surgical procedure;

Local or topical anesthetic or metacarpal or digital anesthetic blocks; and

Normal, uncomplicated follow-up (post-operative) care.

However, preoperative services are not included in this CPT definition, although they are under Medicare. The CPT surgical package definition applies to all codes in the surgery section that are not starred procedures. This means that all the components are included in a single charge for the surgical procedure. From a strict CPT standpoint, the global package consists only of normal, uncomplicated follow-up care.

Major Surgeries Outlined

Medicares global package concept for major surgery includes all post-operative visits, supplies, and post-operative pain management for 0-10 days following surgery for minor procedures and endoscopies, and for 90 days following major surgeries, according to Section 4821 of the Medicare Carriers Manual (MCM). Medicares global package for major surgeries outlined in the manual states:

- All post-operative visits by the surgeon are
included in the fee for the surgery for the
designated [...]