Understanding the global period and surgical package rules is pivotal—especially when trying to avoid denials and underpayments. This post dives into the mechanics of 10-day and 90-day global periods, what's included in these packages, and how and when to use modifier 79.
What Is a Global Period?
The global period is a time frame after a surgical procedure during which all routine care is bundled into a single payment. This means post-op checkups, minor complications that don’t require a return to the OR, and certain related services are included in the original reimbursement. The goal? Simplify payment structures and reduce disputes over what's covered.
10-Day Global Period
The 10-day global period is considered a "minor surgery" package. It includes the day of the procedure plus 10 additional days. Services related to the surgery within this time are not separately billable. But don't let the term "minor" mislead you. Complexity can still exist—especially when patients face common complications.
Example: A dermatologist removes a skin lesion. The office visit for the removal and routine follow-up within those 10 days all fall under this global period.
90-Day Global Period
Longer and often more complex, the 90-day global period applies to major surgeries. It includes the day before surgery, the day of, and 90 days after. This package covers pre-op visits, the surgery itself, and all related post-op care.
Example: Consider a hip replacement. Pre-op evaluations the day before, the surgery, and follow-up visits over the next three months are bundled. But if a patient develops an infection needing a return to the OR, that’s outside the global period.
What's Included in the Surgical Package?
Understanding what’s bundled is the first step to ensuring correct billing—and it’s a bit of a mixed bag. Typically, these services are included:
Pre-operative visits (within 24 hours for major surgeries)
Intra-operative services—basic and necessary
Complications not requiring additional trips to the OR
Post-op pain management
Miscellaneous post-surgical visits (again, routine ones)
However, note that some things aren’t included:
Initial consultation (if separate from the decision to perform surgery)
Unrelated issues or complications that demand intervention
Distinct diagnostic services
When to Use Modifier 79
Modifier 79 is your go-to tool when a patient requires an unrelated procedure during the global period of the first surgery. It signals that the second procedure is not part of the original surgery’s post-op care—crucial for getting paid correctly.
Practical Example
Let’s say a patient undergoes cataract surgery with a global period of 90 days. Two months in, they break an arm and need surgery. You’d append modifier 79 to the surgical code for the arm repair, clarifying its independence from the eye surgery. Without this modifier, expect denials.
Common Pitfalls and Workarounds
Missing modifier 79: Many denials stem from overlooking this key modifier. Train staff to identify when multiple surgeries occur within overlapping global periods.
Payer-specific quirks: Some payers have peculiar rules. For instance, Medicare often follows one set of guidelines, while private payers may deviate. Always check payer contracts or portals.
Documentation deficiencies: If it’s not documented, it didn’t happen—and it won’t get paid. Ensure detailed records back up any claims beyond standard package inclusions.
Final Thoughts
The global period can feel restrictive, but it’s not a straitjacket. Knowing what’s included in surgical packages and when to use modifiers like 79 can safeguard your bottom line against unnecessary denials. Stay vigilant, document thoroughly, and navigate payer specifics with precision. These efforts keep revenue flowing and disputes to a minimum—because every dollar counts.
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