Good old Medicare and their mountains of rules says that any pre-operative visits after the decision for surgery has been made and prior to the surgery itself are considered part of the global package. Once the decision was made, apparently that sealed the deal. So depending on the situation, I'd find out what these visits were for and if they had anything to do with the surgery, then I guess they're stuck in the global period. This would include visits for additional pre-op workup according to the guidelines. It seems odd that a decision would be made AND THEN subsequent visits would occur "just to make sure." It makes me wonder if the 57 actually did belong on that particular DOS.
If it were me, I think the avenue I'd go down is to read all the notes for the decision DOS and the visits in-between and figure out if the decision was rescinded and then decided again later (closer to the actual surgery date). If that's the case, I'd get the original claim billed with the 57 reprocessed to reflect no modifiers and support that with documentation to show the decision was made but then rescinded upon or that the decision made that day was dependent upon such and such testing (which would explain the visits in the meantime) so that DOS no longer was a decision date. I'd probably try the appeal route and include proof that the decision was finalized "for sure" at a later date and make sure THAT claim was billed with the 27, subsequently asking for a reprocessing of the original DOS with the removal of the 27. I'd assume that you'd have to get the appeal done and approved before you could submit the new claim with the 57, IF that was the case.
If the surgery was minor and had a 10 day global period, but a month passed, then I'd still appeal for reprocessing of the original claim, asking to remove the 27, because it would look kind of shady in an audit... like a way to squeeze in some extra visits to get paid before the procedure kind of situation. I don't think I'd let that just play out, mostly just to make sure I cover myself if anything were to come of it. Not saying that's the case here, but better to be proactive than to get a "come to the principal's office" letter from the payer.
