Global surgical packages

Applies to:

All plans

Definition

CPT (Current Procedural Terminology) defines the surgical package as services provided by the physician for specific services that are

  • Included in a given CPT surgical code, and
  • Are always included in addition to the surgical procedure itself.

The services provided by a physician to any patient are by their very nature variable, but the global package remains the same. Global surgical package CPT codes are based on CMS (Centers for Medicare and Medicaid Services) methodologies.

Also see: DRG and outliers billing information.

Global surgical packages billing

Days included in a global surgical package

Major procedures

  • The day prior to a major procedure
  • The procedure
  • The 90-day global period following a major procedure

Minor procedures

  • The day of the minor procedure
  • The procedure
  • The 10-day global period following the minor procedure

Priority Health applies pre-treatment or follow-up edits to all services related to the surgical global package whether the post-operative period is 10 or 90 days. See below for details of the surgical package based on CPT guidelines.

Settings

Global surgery applies in any setting, including:

  • Inpatient/outpatient
  • Intensive care
  • Critical care units
  • Ambulatory surgical centers (ASCs)
  • Offices

Pre-treatment day – day prior (major procedure) or day of (minor procedure)

  • Decision for surgery: Excluded from global surgical package. Append appropriate modifier.
  • Reference CPT guidelines within the CPT manual for additional information.
  • Billing for pre-operative care only: Refer to modifier 56 guidelines.

Surgical services

Surgical services include:

  • Local infiltration, metacarpal/metatarsal/digital block or topical anesthesia
  • Surgical service(s) and related procedures, techniques, etc.
  • Immediate post-operative care, including dictating surgical (operative note), meeting/discussing patient with family and other physicians
  • Evaluating the patient in post-anesthesia/recovery area
  • Writing orders for the patient

Services may also include conscious sedation (99143-99145)

If billing for surgical care only, refer to modifier 54 guidelines.

Post-operative period

Includes:

  • All post-operative follow-up care days (10 days or 90 days depending on procedure performed)
  • All related services other than a return to the operating room

Unrelated E&M services that occur within the post-operative period should be appended with the appropriate modifier. Documentation must support the unrelated services. 

If billing for post-operative care only, refer to modifier 55 guidelines.