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Understanding global fee periods
The standardization of global fee periods among Medicare carriers helps ensure accurate billing and comprehensive patient care.
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A global fee for surgical procedures is a concept established by third-party payers. Under such a system, a single fee is billed and paid for all necessary services normally furnished by the surgeon before, during and after a procedure.
Recognizing that global fee periods varied greatly between carriers, Medicare implemented standardized global fee periods as part of the Physician Payment Reform Act in 1992. For major surgeries, Medicare applied a global fee period of 1 day before surgery, the day of surgery and 90 days following the date of surgery. For minor surgeries, the global fee period is the day of surgery and zero or 10 days immediately following the date of surgery.
The services included in the global surgical package may be furnished in any setting, such as the hospital, ambulatory surgery center or physician’s office. Medicare payment for surgical procedures includes the following services when furnished by the physician who performs the surgery:
- Preoperative visits (1 day before major surgery and the day of minor surgery);
- Intraoperative services that are normally a usual and necessary part of a surgical procedure;
- Complications after surgery that do not require additional trips to the operating room (medical and surgical services only);
- Postoperative visits during the postoperative period of the surgery (zero, 10 or 90 days) that are related to recovery from the surgery;
- Supplies used that are related to the surgery;
- Miscellaneous items used during the surgical procedure that are related to the surgery, such as dressing changes, local incisional care, removal of operative pack and removal of sutures, staples, lines, wires, tubes or drains.
The following services provided to a Medicare patient are not included in the global surgery package and may be billed separately. In some instances, providers will have to bill with the appropriate modifiers as indicated:
- Initial consultation or evaluation to determine the need for major surgery (modifier 57);
- Services of other physicians, except when the surgeon and the other physician or physicians agree on transferring patient care outside the group practice (agreement may be in the form of a letter or an annotation in the discharge summary, hospital record or ASC record);
- Visits unrelated to the diagnosis for which the surgical procedure is performed (modifier 24);
- Treatment for the underlying condition or an added course of treatment that is not part of normal recovery from surgery, such as a fluorouracil injection following trabeculectomy (modifier 58 or 79); a new postoperative period begins with the subsequent procedure;
- Diagnostic tests not normally a part of the surgical procedure;
- Unrelated surgical procedures during the postoperative period that are not reoperations or treatment for complications (modifier 79);
- Treatment for postoperative complications that requires a return trip to the operating room (modifier 78);
- If a less extensive procedure fails and a more extensive procedure is required, the second procedure is payable separately, such as argon laser trabeculoplasty followed by a trabeculectomy or pneumatic retinopexy followed by a scleral buckle repair of a detachment (modifier 58).
An operating room is defined for this purpose as a place of service specifically equipped and staffed for the sole purpose of performing procedures, such as a hospital or ambulatory surgery center operating room, laser suite or dedicated surgical room in the physician’s office. It does not include a patient lane or examination room.
Visits by the same physician on the same day as a minor surgery are included in the payment for the procedure, unless a significant, separately identifiable service is also performed. For example, a visit on the same day could be properly billed in addition to a foreign body removal if a full eye examination is made for a patient complaining of pain in and around the eye. Billing of the visit would not be appropriate if the physician immediately identified the need for epilation trichiasis and only removed the eyelash. A separately identifiable exam performed on the same day as a minor surgery would require a 25 modifier.
There are also occasions when more than one physician provides services included in the global surgical package. Sometimes when a physician performs a surgical procedure and does not furnish the follow-up care, payment for the post - operative care is split between two or more physicians when the physicians agree on the transfer of care. When a transfer of care does occur, the services of another physician may be paid separately if medically necessary. Modifiers 54 and 55 would be required to bill comanaged care.
Careful monitoring of the global fee periods and correct use of modifiers will help to ensure that all services are appropriately billed to Medicare. Inappropriate billing and fragmentation of services could result in unnecessary denials. In today’s environment of increased Medicare audits, it is more important than ever for services to be correctly billed and in compliance with Medicare regulations.
For Your Information:
- E. Ann Rose is president of Rose & Associates. She can be reached at 402 W. Wheatland, Suite 150, Duncanville, TX 75116; (800) 720-9667; fax: (972) 780-8546; e-mail: results@roseandassociates.com.