Cardiology Coding Alert

The global surgical package includes most but not all services and procedures performed after a procedure. According to section 4821of the Medicare Carriers Manual (MCM), the global surgical package includes the following when furnished by the physician who performed the original procedure:

Any preoperative visit made after the decision to operate, beginning with the day before surgery for major procedures and the day of surgery for minor procedures

Any intraoperative services that are normally a usual and necessary part of a surgical procedure

Any medical or surgical service to treat complications that do not require an additional trip to the operating room

Any postoperative visits related to surgery recovery. The 90-day global period begins the day before surgery and extends for 90 days after the surgery. The 10-day global period includes the day of surgery and 10 postoperative days.

The zero-day global includes services performed on the same day, which amounts to a 24-hour "global period." However, subsequent services and procedures may be reported separately. Not all procedures and services are included in the global package, which complicates coding. According to the MCM, the following may be reported separately: The E/M visit that determined the need for surgery

Services of other physicians except where the surgeon and the other physician(s) agree on the transfer of care

Visits unrelated to the diagnosis for the surgical procedure, unless the visits occur due to complications of the surgery

Treatment for the underlying condition or additional treatment not usually part of surgery recovery

Diagnostic tests and procedures

Distinct surgical procedures during the postoperative period (not including reoperations) such as staged procedures that are done in two or more parts where the decision to stage (prospectively schedule) the procedure is made

Treatment for postoperative complications that require a return to the OR (including cardiac catheterization suites, laser suites and endoscopy suites, but not a patient's room, minor treatment room, recovery room, or an intensive care unit, unless the patient's care is so critical that there is no time for transport to an OR)

Critical care services (where a severely injured or burned patient is critical and requires constant attendance by the physician).