I'm not sure where you read it, but I know this is referenced in the
Medicare Global Surgery booklet. It is not a new guideline. Specifically:
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 pre-operative 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
To me, some of this depends on how your office manages surgery scheduling. In my practice, the physician decides surgery is needed. The patient is consented at that visit, basic coordination information and an informational brochure is given, and all other logistics are handled via phone over the next few days. The patient does not typically have another visit, and simply meets with the physician in the hospital the morning of surgery. Additional hospital consents are signed at that time.
There are some practices where the physician decides on surgery and discusses R/B/A, etc. Then the patient comes into the office another time to sign consent and discuss coordinating surgery date, PST, medical clearances, etc. The coding theory is there really is no medical necessity for that second visit and you are paid for that work and MDM at the first visit. It is included in the global surgical package per Medicare guidelines. I also know some physicians like to remind the patient closer to surgery date of the R/B/A. If that is done as a visit, without additional information or changes, that would also be included in the surgical package.
In a scenario where physician decides on surgery and coordination work is done, then before surgery takes place, patient has a change of situation (newly diagnosed DM, stroke, significant symptom improvement or worsening), and patient may be instructed to return. In that case, I would consider the physician is making a new medical decision with this additional information. It could be decided surgery is too high risk, or consider alternative treatments. To me, that is not included in the global surgery package, even if the physician winds up with the same final decision.
I hope that helps!