A routine follow up or a complication is considered part of the global surgery package by CMS. However, additional treatment of the underlying condition is outside the global surgery package.
CMS is currently revising the global surgery booklet, but here are excerpts from the most recent (September 2018):
What services are included in the global surgery payment?
Medicare includes the following services in the global surgery payment when provided in addition to the surgery:
• Pre-operative visits after the decision is made to operate. For major procedures, this includes preoperative visits the day before the day of surgery. For minor procedures, this includes pre-operative
visits the day of surgery.
• Intra-operative services that are normally a usual and necessary part of a surgical procedure
• All additional medical or surgical services required of the surgeon during the post-operative period of
the surgery because of complications, which do not require additional trips to the operating room
• Follow-up visits during the post-operative period of the surgery that are related to recovery from
the surgery
• Post-surgical pain management by the surgeon
• Supplies, except for those identified as exclusions
• Miscellaneous services, such as dressing changes, local incision care, removal of operative pack,
removal of cutaneous sutures and staples, lines, wires, tubes, drains, casts, and splints; insertion,
irrigation, and removal of urinary catheters, routine peripheral intravenous lines, nasogastric and rectal
tubes; and changes and removal of tracheostomy tubes
What services are not included in the global surgery payment?
The following services are not included in the global surgical payment. These services may be billed and paid
for separately:
• Initial consultation or evaluation of the problem by the surgeon to determine the need for major
surgeries. This is billed separately using the modifier “-57” (Decision for Surgery). This visit may be
billed separately only for major surgical procedures.
• Services of other physicians related to the surgery, except where the surgeon and the other
physician(s) agree on the transfer of care. This agreement may be in the form of a letter or an
annotation in the discharge summary, hospital record, or ASC record.
• Visits unrelated to the diagnosis for which the surgical procedure is performed, unless the visits occur
due to complications of the surgery
• Treatment for the underlying condition or an added course of treatment which is not part of normal
recovery from surgery
• Diagnostic tests and procedures, including diagnostic radiological procedures
• Clearly distinct surgical procedures that occur during the post-operative period which are not
re-operations or treatment for complications
• Treatment for post-operative complications requiring a return trip to the Operating Room (OR). An
OR, for this purpose, is defined as a place of service specifically equipped and staffed for the sole
purpose of performing procedures. The term includes a cardiac catheterization suite, a laser suite, and
an endoscopy suite. It does not include a patient’s room, a minor treatment room, a recovery room, or
an intensive care unit (unless the patient’s condition was so critical there would be insufficient time for
transportation to an OR).
• If a less extensive procedure fails, and a more extensive procedure is required, the second procedure
is payable separately.
• Immunosuppressive therapy for organ transplants
• Critical care services (CPT codes 99291 and 99292) unrelated to the surgery where a seriously injured
or burned patient is critically ill and requires constant attendance of the physician