Wiki global period BEFORE surgery???

[LaSeille]

Please help! SCENARIO: Patient is seen in surgeon's office for an office visit, and the surgeon decides that the patient needs surgery.

It is my understanding that if the surgery is to be performed the same day or the next day, modifer 57 should be added to the office visit code in order to receive payment for both the office visit AND the surgery. However, if the surgery is done two days after the office visit, then no modifier is needed.

First, is my assumption correct?

Second, is anyone aware of any insurance carriers that have a specific "pre-surgery global period"??

We received two denied claims (two different carriers) for office visits that were performed two days before surgery and both EOB's stated that the office visit was inclusive with the surgery.

Thanks for any insight to this matter.

 

[btadlock1]

Please help! SCENARIO: Patient is seen in surgeon's office for an office visit, and the surgeon decides that the patient needs surgery.

It is my understanding that if the surgery is to be performed the same day or the next day, modifer 57 should be added to the office visit code in order to receive payment for both the office visit AND the surgery. However, if the surgery is done two days after the office visit, then no modifier is needed.

First, is my assumption correct?

Second, is anyone aware of any insurance carriers that have a specific "pre-surgery global period"??

We received two denied claims (two different carriers) for office visits that were performed two days before surgery and both EOB's stated that the office visit was inclusive with the surgery.

Thanks for any insight to this matter.

You add the 57 modifier, even if the surgery has been scheduled more then one day after the E/M where the decision for surgery was made. This allows payers to differentiate between a pre-op clearance visit (which is global) and the visit that led to the procedure. You would not add a 25 modifier to any other (unrelated) visits between the decision for surgery and the surgery, but you might have to send office notes to show that the said visits were separate and not related to the surgery. You can't bill for the pre-op clearance, though. I hope I explained that in a way that didn't make it more confusing!

Let me know if you have any other questions, though...