What Is Global Period in Medical Billing?

The global period in medical billing defines a timeframe that bundles various services related to a surgical procedure under a single payment. This approach simplifies billing by preventing fragmented claims for individual components of care surrounding a surgery. It is a fundamental aspect of the global surgery concept, primarily initiated by Medicare, which helps manage costs and provides a clearer financial picture for patients and providers.

Understanding the Global Period

The global period defines a specific timeframe during which all services related to a surgical procedure are considered part of a single payment. Its primary purpose is to bundle related services, such as preoperative, intraoperative, and postoperative care, into one comprehensive fee, preventing separate billing for each individual component. This bundling helps to simplify the billing process for healthcare providers and clarifies insurance coverage for patients.

The duration of a global period varies depending on the complexity and nature of the procedure performed. The Centers for Medicare & Medicaid Services (CMS) categorizes procedures into three main global period types. A 0-day global period applies to minor procedures, meaning only the procedure itself on the day of surgery is included, and no preoperative or postoperative care is part of the bundled fee.

For minor surgeries requiring some follow-up, a 10-day global period is common, which includes care on the day of the procedure and routine postoperative care for 10 days following the surgery. Major surgeries typically have a 90-day global period. This longer period encompasses preoperative care starting one day before the procedure, the surgery itself, and all routine postoperative care for 90 days following the surgery.

Services Bundled into the Global Fee

The global surgical package includes various components that are bundled into a single fee. This consolidation aims to cover the entire course of typical care associated with a surgical procedure. These bundled services include preoperative visits, which typically occur one day before a major surgery or on the day of a minor surgery, for evaluations and consultations that determine the patient’s fitness for the procedure.

The actual surgical procedure itself, known as intraoperative services, forms the core of the global fee. This covers the performance of the operation by the surgeon. Following the surgery, routine postoperative care is also integrated into the global payment.

Routine postoperative care encompasses various follow-up services directly related to recovery from the surgery. This includes services such as dressing changes, removal of sutures or staples, and management of pain directly associated with the procedure. Any routine follow-up visits within the defined global period, whether for wound checks or general recovery assessment, are considered part of this bundled fee.

Services Billed Separately

Certain medical services are not included in the global surgical package and can be billed separately.

Initial consultation visits, if distinct from the decision to operate, such as a consultation to diagnose a condition that later leads to surgery.
Services unrelated to the original surgical procedure, even if performed within the global period. For example, treatment for a new medical condition like an ear infection arising during recovery from knee surgery.
Services by different physicians for unrelated issues. If a patient sees their primary care physician for a cold during their surgical global period, that visit can be billed separately.
Staged procedures that require distinct planning and are not part of the initial surgical plan, especially if more extensive or representing a new course of treatment.

Applying Modifiers in Global Period Billing

CPT modifiers are important in medical billing for indicating exceptions or special circumstances related to global periods. These two-digit codes are appended to CPT codes to provide additional information to payers, allowing for separate billing of services that might otherwise be considered part of the global package. Proper modifier use helps ensure accurate reimbursement and avoid claim denials.

Modifier 24: Used when an unrelated Evaluation and Management (E/M) service is provided by the same physician during a postoperative period. This modifier signals that the E/M service addresses a new problem or condition distinct from the original surgery, even though it occurs within the global period. For instance, if a patient has shoulder surgery with a 90-day global period but returns for a new episode of knee pain, the E/M visit for the knee issue would be reported with Modifier 24. This modifier is used for procedures with 10- or 90-day global periods, as 0-day global procedures do not include postoperative care.
Modifier 58: Indicates that a procedure performed during the postoperative period was either planned prospectively at the time of the original procedure, was more extensive than the original procedure, or represents therapy following a diagnostic surgical procedure. This modifier is used for staged or related procedures and results in a new global period for the subsequent procedure. An example includes a planned second stage of a reconstructive surgery that was anticipated during the initial operation.
Modifier 78: Applied for an unplanned return to the operating room by the same physician for a related procedure during the postoperative period. This modifier is used when a complication from the initial surgery necessitates a return to the operating room for an intervention. Modifier 78 does not initiate a new global period; the original global period continues, and the reimbursement for the second procedure is typically at a reduced rate, as it addresses a complication of the initial surgery.
Modifier 79: Used for an unrelated procedure or service performed by the same physician during the postoperative period. Unlike Modifier 78, Modifier 79 signifies that the second procedure is completely independent of the original surgery and its complications. Using Modifier 79 initiates a new global period for the unrelated procedure, allowing it to be billed separately. An example would be a patient undergoing cataract surgery on one eye, and then, within that global period, having unrelated cataract surgery on the other eye.