What is the Global Period in Medical Billing?

Did you know that surgical procedures are often billed under a global surgical package? This package includes reimbursement for all routine care, preoperative, and postoperative services related to the surgery. 

But why are we discussing it? Because if you do not know what is included or excluded in a global period, you can waste your time submitting a claim against unbillable services. This will lead to a higher denial rate, audit risks, and a strained revenue cycle.

Today’s guide covers everything you need to know to steer clear of payment delays when it comes to global surgical packages. So, continue reading!

Importance of Global Period in Medical Billing

The following are some of the benefits of understanding the global period in medical billing:

• It guarantees compliance with federal programs (Medicare, Medicaid) and private payer guidelines for global surgical packages.
• It prevents unbundling of services.
• With the proper global period-related modifiers, you secure payments for unrelated services provided in the global window.
• Moreover, when you know what the global surgical package includes, it becomes easier to identify which follow-up visits are included.

Global Periods Types with CPT Codes

There are three types of global windows:

0-Day Global Period

A 0-day global period only includes the payment for the day of the procedure. That is, it does not cover preoperative or postoperative days. Typically, minor procedures, endoscopies, or diagnostic tests fall under this category.

Some of the common CPT codes with a 0-day global period are listed below:

CPT Codes	Description
11042	Surgical debridement of skin down to subcutaneous tissue, including epidermis and dermis, for the first 20 sq cm.
43239	It describes EGD with biopsy. A flexible endoscope is inserted to collect tissue from the esophagus, stomach, or duodenum for analysis.
93451	It covers right heart catheterization. It involves accessing the percutaneous venous to obtain oxygen saturation and evaluate cardiac output via fluoroscopy.

10-Day Global Period

This type of global period covers reimbursement for the day of the surgery and the 10 days of postoperative care immediately following it. Mostly, minor surgical procedures with a brief recovery time fall under this category.

The table below shows a few common CPT codes with a 10-day global period:

CPT Codes	Description
10060	It includes a simple incision and drainage of a superficial abscess or cyst using a single cut to drain pus and fluid.
12044	This procedural code describes intermediate repair of superficial wounds (7.6 to 12.5 cm) on the neck, hands, feet, or external genitalia.
69433	It covers the creation of a small eardrum opening to insert a ventilating tube while under local or topical anesthesia.

90-Day Global Period

This type of global period in medical billing includes payment for 1 day before the surgery (preoperative care), the day of surgery, and 90 days following the surgery (postoperative care). 

Major surgical procedures that require an extensive recovery period typically fall under this category. Some examples are discussed below:

CPT Codes	Description
27130	It describes total hip arthroplasty, which involves the surgical replacement of femoral and acetabular components with a prosthetic joint.
47562	It covers the removal of the gallbladder using a camera and instruments via abdominal incisions (laparoscopic cholecystectomy).
63030	Lumbar laminotomy and decompression of nerve roots, including excision of a herniated disc at one interspace.

Global Period Services – Coverage

Are you confused about what a standard global surgical package includes? It covers reimbursement for the following care services rendered by the same healthcare physician who performed the surgery:

Preoperative Visits

It includes all the evaluation and management (E/M) services the physician renders on the day before or the day of the surgical procedure.

Intraoperative Services

The global package covers all routine elements of the surgical procedure itself. This includes anesthesia administration and surgery assistance services.

Postoperative Care

Once the surgery is complete, the global period package also covers all the postoperative care services. These include:

• Follow-up visits.
• Wound care management/
• Post-surgery complication management that does not require return to the operating room.
• Removal of staples, tubes, stitches, cutaneous sutures, casts, and splints.

Global Surgical Package – Exclusions

We have discussed what is included in the global surgical package. But, understanding what is excluded is also integral to ensuring accurate global period billing:

Initial E/M for Major Surgery

What happens when the physician decides to perform a major surgery during an E/M visit? Moreover, the surgery may be performed the same day or the next day. In this case, the E/M visit is not included in the global surgical package.

Unrelated E/M Service

Oftentimes, healthcare practitioners encounter patients with conditions entirely separate from the surgical diagnosis. For example, chronic hypertension management during the recovery period of a hip replacement surgery. 

The reimbursements for these unrelated E/M visits are not covered under the global period package.

Diagnostic Tests & Procedures

All diagnostic tests and procedures are also excluded from the global surgical package. That is, you should always bill them separately.

Unplanned Return to Operating Room

The global surgical package does not cover the patient’s unplanned return to the operating room. This exclusion applies to both unrelated and related procedures.

Staged or Planned Procedures

When physicians anticipate the patient’s return to the operating room, they record it in the operative notes of the initial surgery. That is, planned or staged surgeries are not included in the global period surgical package.

Modifiers for Global Period Billing

Let’s review some of the common modifiers to ensure error-free global period billing:

Modifier 24

What happens when the same physician encounters the patient for an unrelated E/M service during the postoperative period? You append modifier 24 to highlight to the payer that the service requires a separate reimbursement since it is unrelated to the surgery.

Modifier 57

Modifier 57 indicates an E/M visit in which the healthcare practitioner decided to perform a major surgery (90-day global period) on the same day or a day after. The payment for this E/M visit is excluded from the global period package. 

Modifier 58

Another integral global period-related modifier is 58!

Assume a scenario where the surgeon performs a debridement of a deep skin infection. Besides, he notes in the record that the wound is too extensive to close immediately. Therefore, he plans a second session for a skin graft five days later once the site is stable.

Now, you should bill the second surgery with modifier 58 to highlight to the payer that it was a staged or planned procedure.

Note that the second staged procedure must be performed within the postoperative period of the initial procedure. 

Modifier 78

Did the patient return to the operating room for an unplanned and related procedure during the postoperative period? If yes, report the procedure with modifier 78.

Modifier 79

What happens when the patient returns to the operating room for an unplanned and unrelated procedure to the original surgery during the postoperative period? You append modifier 79.

Challenges in Global Period Billing

Discussed below are some of the key challenges related to global period billing:

• Misuse or overuse of modifiers can trigger audits and immediate claim denials.
• Typically, treatment for postoperative complications is covered in the global window. However, if it requires a return to the operating room, you must append the relevant modifier, i.e., 78 or 79.
• The global package may vary across periods. Note that Medicare follows a strict 0-, 10-, 90-day rule. However, some private payers may have their own global window-related policies for specific procedural codes.
• Documentation gap is another cause of claim denials. For example, if you want to get accurate reimbursement for an E/M service that is unrelated to the surgery, the patient’s medical records and documentation must support it.
• Additionally, managing overlapping global periods can create significant administrative overhead and confusion.

Final Thoughts

To summarize, the global period in medical billing is a fixed window for a surgical procedure for which preoperative, intraoperative, and postoperative care services are bundled into a single payment. It can vary from 0 to 90 days, depending on the procedure complexity.

Additionally, there are special modifiers, such as 24, 57, 58, 78, and 79, that you can use to report the exclusions. Hopefully, with this guide, billing for procedures during the global window will become seamless. 

However, if you still struggle, feel free to outsource medical billing and coding services to professionals, like NeuraBill.

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