What CPT Codes Have a 90-Day Global Period?

A “global period” refers to a specific timeframe surrounding a surgical procedure during which all related care provided by the surgeon is considered part of a single bundled payment. Understanding these global periods, particularly the 90-day duration, is important for financial management in healthcare.

Defining the Global Surgical Package

A global surgical package bundles all necessary services furnished by a surgeon before, during, and after a procedure into a single payment. This simplifies billing by accounting for routine care associated with a surgery. The package includes pre-operative care, such as initial evaluation and decision for surgery, and intra-operative services, covering the procedure from incision to closure.

Post-operative care is a substantial part of the global package, covering routine follow-up visits, dressing changes, and suture removal. While global periods vary (e.g., 0-day for minor procedures, 10-day for intermediate), the 90-day global period signifies major surgical procedures. This extended duration reflects the complexity and recovery time of significant interventions.

For procedures with a 90-day global period, the bundled payment covers routine post-operative visits, wound care, and pain management directly related to the surgery for 90 days. This payment includes all routine follow-up visits or minor procedures performed during this period, as long as they are related to the original surgery. For example, multiple dressing changes or re-examinations for expected post-operative pain are part of the initial surgical fee.

Locating CPT Codes with a 90-Day Global Period

Information regarding global periods for CPT codes is publicly available through official sources. One primary resource is the American Medical Association’s (AMA) CPT manual, which provides codes and guidelines. While the CPT manual outlines codes, it typically directs users to payer-specific information for global period details.

The Centers for Medicare & Medicaid Services (CMS) Physician Fee Schedule Look-Up Tool is a widely used and authoritative source for identifying global periods for Medicare beneficiaries. This online tool allows users to search for specific CPT codes and view detailed information, including the assigned global period indicator. The global period indicator is usually displayed as a numerical value, such as ’90’ for a 90-day global period. Other indicators include ‘XXX’ (global concept does not apply) and ‘YYY’ (global period defined by carrier).

Understanding the different global period indicators is important. For instance, a ‘000’ or ‘010’ indicator denotes procedures with 0 or 10 global days, respectively. The ’90’ indicator explicitly identifies procedures with a 90-day global period, signifying major surgeries.

Consulting the most current versions of these resources is important, as information on CPT codes and their global periods is regularly updated. Healthcare policies and coding guidelines can change, making it necessary to use the latest editions of manuals and online tools to ensure accuracy. Relying on outdated information could lead to billing errors or compliance issues.

Billing Rules for 90-Day Global Periods

The single payment for a 90-day global package covers all standard related care provided by the same physician or group practice. This means that for 90 days following a major surgical procedure, routine post-operative visits and services directly related to the surgery are included in the initial surgical fee. However, certain services rendered during this period are not part of the global package and can be billed separately.

Services not included in the global package may encompass an initial evaluation and management (E/M) service that leads to the decision for surgery, provided it is separate and distinct from the procedure itself. For example, if a patient’s visit to a surgeon results in the decision to perform surgery on a different day, the E/M service may be billed separately with modifier -25. Diagnostic tests, such as X-rays or laboratory work, are also excluded from the global package and can be billed independently.

Unrelated services provided during the 90-day global period can also be billed separately. For instance, if a patient undergoes knee surgery and then develops an unrelated skin rash 60 days later, the evaluation and treatment of the rash are not part of the knee surgery’s global package. Modifier -24 would be appended to the E/M code for the rash, indicating an unrelated E/M service by the same physician during a post-operative period.

Services for complications requiring a return to the operating room are billable. If a patient experiences a complication that necessitates another trip to the operating room, modifier -78 can be used. Modifier -58 signifies a staged or related procedure performed during the post-operative period. Modifier -79 is used for an unrelated procedure or service by the same physician during the post-operative period.

When services are provided by different, unrelated providers, they are not subject to the original surgeon’s global period. For example, if a patient sees a physical therapist for rehabilitation after surgery, the physical therapist can bill for their services. Similarly, if another physician treats a completely different condition during the 90-day period, their services are billable. Services performed by another provider for the same condition during the global period may be billed if appropriate documentation supports the medical necessity and the service is truly distinct from the original surgeon’s responsibilities.