The Global Surgical Package and E/M Services- Get the Facts

A global surgical package references the CMS payment policy that may “bundle” the reimbursement of a related Evaluation and Management service as part of a “surgical procedure”.  The rationale for the bundling is simple; the E and M service is a necessary part of the larger surgical service being provided.

  The “global period” has 7 unique designations that are related to the specific surgical service performed and are indicated on the Medicare physician fee schedule database(MPFSDB).  You are able to search by a single HCPCs code, a list of up to five codes, or a range of codes.  The results when downloaded to an excel spreadsheet show the global period indicator in column “AL” (see graphic below).

The 7 categories shown above consist of:

• 3 numeric indicators: 0, 10, or 90 days specifying the post-operative timeline that is considered the “global period”.  CMS has provided the following details in regards to each period:

000 -- Endoscopic or minor procedure with related preoperative and postoperative relative values on the day of the procedure only included in the fee schedule payment amount; evaluation and management services on the day of the procedure generally not payable.

010 -- Minor procedure with preoperative relative values on the day of the procedure and postoperative relative values during a 10-day postoperative period included in the fee schedule amount; evaluation and management services on the day of the procedure and during this 10-day postoperative period generally not payable.

Calculate the global period by counting the day of surgery and 10 subsequent days to equal 11 days.

090 -- Major surgery with a 1-day preoperative period and 90-day postoperative period included in the fee schedule payment amount.

Calculate the global period by counting the day before, day of and 90 subsequent days after the surgery to equal 92 days.

• 4 alphabetic codes: MMM, XXX, YYY, ZZZ that are used to furnish additional necessary information about the status of the surgical codes as they related to the CMS global surgery reimbursement guidelines.

MMM -- Maternity codes; usual global period does not apply.

XXX -- Global concept does not apply.

YYY -- Carrier determines whether global concept applies and establishes postoperative period, if appropriate, at time of pricing. 

Each FI/MAC sets its own rules.

ZZZ -- Code related to another service and is always included in the global period of the other service.

 Used for codes that are typically referred to as an “add-on” code that is always billed with another service.

This article has provided a great starting point for understanding the Global Surgery rules that affect the billing of Evaluation and Management services.   If you are interested in expanding your knowledge of this topic, you can find a wealth of information by following these CMS links:

http://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/downloads/GloballSurgery-ICN907166.pdf

http://www.cms.gov/manuals/downloads/clm104c12.pdf