90 Day (+2): Major Surgery Global
- By John Verhovshek
- In Billing
- April 25, 2018
- Comments Off on 90 Day (+2): Major Surgery Global
Per national Correct Coding Initiative (CCI) Chapter 3 guidelines, a procedure with a 90 day global period “is defined as a major surgical procedure.” The 90 day global period actually extends to 92 days, to include one day before the day of the surgery, the day of surgery, and the 90 days immediately following the day of surgery, according to the MLN Matters “Global Surgery Booklet.”
Decision for surgery is separate: According to CCI guidelines:
If an E/M is performed on the same date of service as a major surgical procedure for the purpose of deciding whether to perform this surgical procedure, the E&M service is separately reportable with modifier 57. Other preoperative E&M services on the same date of service as a major surgical procedure are included in the global payment for the procedure and are not separately reportable.
To apply modifier 57 Decision for surgery, the E/M service must have led to the decision to perform the major procedure that follows. For example, if surgery was scheduled June 17 and the surgeon sees the patient again the day of the surgery, June 25, you should not report a separate E/M with modifier 57 for the encounter on June 25 because the decision for surgery was not made at that visit. Rather, the June 25 visit is bundled into the surgical package. In contrast, if a patient presents with a burst appendix and the decision for appendectomy is made immediately, the E/M service (for example, 9928x) with modifier 57 appended may be billed separately with 44970 Laparoscopy, surgical, appendectomy.
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My understanding is that if the decision for surgery was made within 24 hours (i.e. could be the day before) modifier 57 could be applied to the EM…that it does not have to be the same calendar date as the major procedure, just within the pre-op period (i.e. the day of or the day before).
How does the NCCI global period affect individual payers like BCBS who states their global period is only 45 days?