Global surgical packages

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.

Global surgery applies in any setting, including:

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

• 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 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.

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.