The medical billing industry is complicated, intimidating, and full of challenges. It’s a whole new world, and understanding every aspect is like finding a needle in a haystack. Global period is one such thing that, although it is an integral part of medical billing, appending it precisely can be mind-boggling.
Considered as the fundamental aspect of surgery, Medicare established a global period to cover extensive surgical treatments and processes. It helps payors determine what’s included in the surgical package and when healthcare providers can submit bills against other services included.
Global Period in Medical Billing According to Department of Labor
According to the US Department of Labor (.gov), “A global period is a period of time starting with a surgical procedure and ending some period of time after the procedure. Many surgeries have a follow-up period during which charges for normal postoperative care are bundled into the global surgery fee. For the Office of Workers’ Compensation (OWCP), no global periods for surgical procedures shall be longer than the period designated by the Centers for Medicare and Medicaid (CMS). Reimbursement for surgical procedures includes payment for all related services and supplies that are routine and necessary to perform the procedure. These components of the surgical package are not eligible for separate reimbursement and will be denied if billed within the global period of the associated procedure.
What is the Global Period in Billing?
It refers to a set timeframe that includes all the necessary surgical procedures covered under a single payment. Global period in medical billing includes post-operative visits or services and post-operative services for specific days. It is important to note that insurance companies don’t usually reimburse for services separately delivered in the global surgical package.
Simply put, a healthcare provider who wants to obtain complete and timely reimbursements against their services cannot bill surgical procedures, post-operative visits, and care separately. Based on the type of surgical procedure, the global period can vary between 0, 10, and 90 days.
Why is Global Period in Medical Billing Essential?
As you may have seen, many patients after a surgical procedure tend to elongate their stay in the hospital or medical clinic for a few more days. Mostly, it is due to the provision of quality care and professional paramedical staff looking after the patient.
During these extra days or period, the healthcare specialists conduct multiple follow-up services, evaluate patients’ condition, visit regularly for the provision of quality care, etc. All this is to ensure that the patient recovers quickly. Now, the fees charged for the additional services are bundled into the global surgery fee.
Every service included, starting from the surgical procedure and ending after some time or a few days, with the inclusion of additional medical care services, is included in the bill. The process or phenomenon holds immense significance in the health industry and especially the medical billing field, as it helps doctors and physicians get reimbursements against their services.
How Does It Help Healthcare Providers?
The best part of the global period in medical billing is the benefits it endows to the healthcare providers. Firstly, it helps them claim full reimbursements against the provision of quality care. Secondly, careful charge capture and documentation enable them to avoid denials resulting from submitting duplicate claims.
Following the process not only simplifies the billing cycle and collection of revenue for practices but also helps balance surgical costs for patients. In simple words, the global period in medical billing streamlines every aspect of the billing process for both parties, the caregiver and receiver.
Here’s how it works:
- It helps standardize the entire billing process for surgical procedures.
- Makes the billing and reimbursement process convenient.
- Helps to disentangle the complications involved, i.e., insurance coverage and limitation.
- Healthcare providers can better identify services covered under global surgical settlement.
- By combining all services within one claim, the process helps medical specialists and their staff reduce administrative burden.
- By lowering complications and ensuring complete reimbursements against medical services, it allows professionals to deliver exceptional surgical care to patients during and after the process.
- For patients, global billing safeguards them from last-minute price shocks, i.e., high out-of-pocket costs.
Types of Global Periods & Common CPT Codes
As defined by the Centers for Medicare & Medicaid Services (CMS), there are three types of global periods followed in the healthcare industry, with each covering a certain amount of time. These are:
- 0-Day Global Period
- 10-Day Global Period
- 90-Day Global Period
For better understanding, let’s give you a brief detail of these periods.
0-Day Global Period
The first and shortest period includes only the procedure on the exact day of surgery. In case of any follow-up care or service provided afterward, the healthcare provider bills it separately.
Example of CPT codes used: The best examples of CPT codes for 10-day global period are 10040 for Acne Surgery and 11042 for Debridement.
10-Day Global Period
This global period holds the middle ground and encompasses the surgical procedure plus routine post-surgery care for 10 days. Any services related to the operation and follow-ups within 10 days is billed at once.
Example of CPT codes used: The best examples of CPT codes for a 10-day global period are 11401 for Benign lesion excision and 12002 for simple wound repair.
90-Day Global Period
The longest of the three, 90-day global period, includes the primary medical procedure to go along with post-operation care for 90 days. It includes billing for each and every follow-up visit or service provided by the healthcare providers or their staff.
Example of CPT codes used: The best examples of CPT codes for a 10-day global period are 27447 for total knee replacement and 66984 for cataract surgery.
What Services Are Delivered Under the Global Period?
Medicare has defined the period for minor as well as critical surgeries. Moreover, as explained by the Centers for Medicare and Medicaid Services (CMS), any surgery that is considered major under the regulations of the American Medical Association (AMA) has a global period that extends till 90 days starting from one day before the surgical procedure.
On the contrary, minor surgeries required to remove moles or biopsies, etc., fall under a 0 to 10-day period starting from the day of treatment. It is important to note that the timeframe, i.e., 0, 10, or 90 days, includes all surgical procedure services such as:
Pre-Surgery Procedure Services
Pre-surgery services or consultation are either done on the D-day or one day prior to the operation. For minor surgeries, healthcare providers usually conduct consultation or provide pre-surgery services on the same day. On the contrary, these services are completed one day before major procedures. These services are usually provided once the decision to operate is finalized.
Intraoperative Services
These include but aren’t limited to all kinds of surgical procedures, anesthesia services, assistance services provided by other healthcare specialists like providing anesthesia, wound closure, bleeding control, etc.
Post-Operative Services
Similar to intraoperative services, post-operative services include a lot of services. Healthcare providers and their assisting staff are very skeptical when it comes to delivering post-operative services.
These include but aren’t limited to:
- Managing bleeding, changing the dressing and supervising the wound.
- Ensuring quick recovery of the wound and that there are no complications in and around the wound.
- Evaluating the surgery, the region around the wound, and keeping a close eye on the patient’s vital signs.
- Closely monitoring and analyzing post-surgical symptoms.
- Handling post-surgery complications (if any).
- Removing cutaneous sutures, staples, casts, splints, and tubes from the surgical region.
- Managing pain and discomfort to ensure the patient is at ease.
- Looking after other conditions affecting the patient.
Note:
It is imperative to note that all healthcare providers, like surgeons, physicians, and anesthesiologists, providing surgical services must follow the global period rule. Otherwise, they may face difficulties in claim submission, extracting complete reimbursements, maintaining practice credibility, and rising denials. It includes most surgical-related services and excludes the following.
- Unrelated consultations
- Treatments for other issues
- Emergency services
- Unplanned separate procedures
Benefits of the Global Period in Medical Billing
Whether a healthcare provider or a patient opting for surgical services, there are several benefits of the global period system for both.
Here are some of these benefits
Simplifies Billing for Patients
The global period ensures that patients aren’t overwhelmed by multiple bills for related care after a procedure. For instance, follow-up visits, routine wound checks, and suture removal are all included in the initial payment. This reduces financial confusion and makes it easier for patients to budget for their healthcare.
Encourages Comprehensive Care
Since follow-up visits are part of the package, patients are more likely to attend their post-operative appointments without worrying about additional costs. This allows surgeons or healthcare specialists to provide thorough, uninterrupted care during recovery.
Reduces Administrative Burden
For healthcare providers, the global period simplifies paperwork and reduces the need to submit multiple claims for related care. This streamlined process allows more focus on patient care rather than repetitive administrative tasks.
Promotes Cost Transparency
The global period provides clarity about the total cost of a procedure. Patients are informed upfront about what’s included, reducing the likelihood of surprise bills later on.
Improves Patient Satisfaction
Patients appreciate the convenience of bundled services. Knowing that their follow-up care is covered builds trust and confidence in the healthcare system. It also strengthens the doctor-patient relationship, as patients feel cared for without additional financial stress.
Supports Better Outcomes
Including follow-up visits in the package incentivizes regular post-operative care, which helps identify and address complications early. This contributes to faster recovery and better overall health outcomes.
Global Period Coding for Surgical Procedures
Grasping the intricacies involved in global surgery, such as the global fee and period, is deemed necessary to avoid inaccurate coding leading to denials and eventually loss of revenue. Usually, healthcare providers append CPT and HCPCS codes to classify specific surgical treatments.
Based on CMS’ global surgery guidelines, healthcare providers delivering services backed by a global package must append a precise CPT code for surgery within the claim. This particular CPT code will cover all pre-, intra-, and post-operative surgery services as part of the global package. To make it easy for you, healthcare providers cannot and should not submit separate bills for multiple visits or include unrelated services in the package.
Modifiers for Global Period Billing
Healthcare providers, their assisting staff, or medical billing and coding specialists use different modifiers in the claim forms to add more details regarding the services within the global period. In case of unrelated treatments or consultations, doctors or physicians will include specific modifiers to highlight these services.
Some common examples of modifiers used in the global period are as follows.
- Modifier 24: Unrelated E/M service during the global period
- Modifier 25: Separate E/M service on the same day as a minor procedure
- Modifier 57: Decision for surgery made during an E/M visit
- Modifier 58: Staged or planned procedure during the post-op period
- Modifier 78: Unplanned return to the OR for a related procedure
- Modifier 79: Unrelated procedure performed during the global period
Being careful in appending the precise codes in claims against surgical treatments in the global period ensures that your claims are approved swiftly, resulting in accurate reimbursement and avoiding painful denials.
Typical Blunders in Global Period Billing and How to Eliminate Them
Billing for the global period can sometimes be tricky, especially if you’re not familiar with the rules. Mistakes can lead to unwanted outcomes like claim denials, payment delays, or even compliance issues. Here’s a simple guide to help you avoid common errors and streamline your global period billing process.
Understand What’s Included in the Global Period
The global period covers the surgery itself, pre-operative visits (one day before major procedures), and post-operative care, including routine follow-ups. Avoid billing separately for services like wound checks, suture removal, or minor complications related to the surgery, as these are already included.
What to do? Keep a checklist of covered services for easy reference.
Know the Length of the Global Period
The duration of the global period varies depending on the procedure. For example:
- 0-day global period: Minor procedures with no follow-up.
- 10-day global period: Minor surgeries requiring short follow-up care.
- 90-day global period: Major surgeries with extensive follow-up.
Mistake to Avoid: Billing for routine care within the global period as though it were unrelated to the procedure.
Document Everything Clearly
Proper documentation is your best defense against errors. Record every visit, service, and conversation related to the procedure. Clearly distinguish between services that are part of the global period and those that aren’t. For instance, if a patient comes in for an unrelated issue, such as a cold, during their global period, document this separately to justify billing.
Use the Correct Modifiers
Modifiers are essential when billing for services outside the global period or unrelated to the procedure. Common modifiers include:
- Modifier 24: For unrelated evaluation and management (E/M) services during the global period.
- Modifier 25: For a significant, separately identifiable E/M service on the same day as the procedure.
- Modifier 79: For unrelated procedures during the global period.
Mistake to Avoid: Forgetting to add the appropriate modifier when billing for unrelated services.
Train Your Staff
If you work with a billing team, arrange the latest industry-related training on global period rules for them. Errors often occur when staff members are unaware of what’s included in the global package. Regular training sessions can prevent misunderstandings and keep everyone updated on the latest billing guidelines.
Verify Insurance Policies
Insurance companies may have their own rules for global period billing. Always verify policies and coverage details for each payer to avoid surprises.
What to do? Maintain a database of payer-specific guidelines for quick reference.
Handle Complications Properly
Minor complications that don’t require a return to the operating room (OR) are part of the global period. However, if a patient needs a second surgery or treatment for a significant issue, you can bill for it separately—just make sure to use the correct modifier and provide detailed documentation.
Use Billing Software
Modern billing software can help you track global periods, flag errors, and ensure accurate claims. Many systems are programmed to follow Medicare and other payer rules, reducing the risk of mistakes.
Final Say
In the end, it is important to note that global period billing isn’t as complicated as it seems. If you apply yourself and focus on understanding the regulations, document every detail correctly, and stay aware of the code updates and insurance submission guidelines, you can easily avoid errors and ensure a swift claim submission, approval, and reimbursement.
By doing the basics right, you can save time, reduce stress, and focus on providing world-class medical services that truly matter for those in need.
If you’re already consumed in providing quality healthcare services and surgical treatments to patients, and don’t find time for administrative tasks like documentation, charge capture, claim submission to insurance, denial management, and extracting the appropriate payment from the insurance companies, you’d better outsource general surgery billing services to I-Med Claim.
We’re a leading revenue cycle management company with various service centers all over the US, enabling us to serve thousands of practices, medical facilities, and hospitals with specialized coding services. Our main aim is to enhance your revenue, speed up reimbursements, eliminate errors, reduce denials, and streamline your revenue cycle with our widely acclaimed global period billing.
