A lot of potential reimbursement is left on the operating table because many surgeons believe that once they perform a surgical procedure, they cant bill for any postoperative visit or procedure, even those totally unrelated to the surgery. The neglected reimbursement reflects widespread confusion over global surgery packages established by the Health Care Financing Administration (HCFA), which administers Medicare.
Nancy King, CPC, a coder at South Louisiana Medical Associates, a multispecialty group (including three general surgeons) at the Leonard Chabert Medical Center in New Orleans, LA, comments, It is confusing because Medicare guidelines say anything connected to surgical procedures is locked. But other guidelines say you can bill if the situation is out of the norm.
Kings uncertainty is shared by many other
general surgery coders and underlines the importance of understanding how the complex global package system works.
Interpreting HCFAs Global Package
HCFA set up the global system with rules and guidelines to ensure standardized reimbursement for the same services across all jurisdictions. The Medicare-approved amount for surgery covered by a global package includes payment for some, but not all, services related to the surgery when furnished by the physician who performs the surgery or by members of the same group within the same specialty. Any care or procedure listed in the package that is performed during the global period10 days for minor procedures, 90 days for major surgerycannot be claimed separately. Postoperative periods also apply to some procedures that may not be considered surgical.
According to CPT 1999 guidelines, listed surgical procedures include the operation per se, local infiltration, metacarpal/digital block or topical anesthesia when used, and normal, uncomplicated follow-up care. This concept is referred to as a package for surgical procedures, commonly referred to as global surgery or the global package.
CPT 1999 goes on to say that follow-up care for diagnostic procedures (e.g., endoscopy, arthroscopy, injection procedures for radiography) includes only that care related to recovery from the diagnostic procedure itself. Care of the condition for which the diagnostic procedure was performed or of other concomitant conditions is not included and may be listed separately.
Note: The Medicare Physician Fee Schedule Data Base (MPFSDB) provides the postoperative periods that apply to each procedure. The payment rules for global surgery apply to codes with entries of 000, 010, and 090 and YYY. Codes with 000 and 010 postoperative periods are either minor procedures or endoscopies; codes with a 090 postoperative period are major surgeries; and codes with YYY are carrier-priced codes, for which the carrier determines the global period.
Complications and New Diagnoses
Like any treatment directly related to the original procedure, routine complications following surgeryinfection, bleeding, leaking anastomosis, perforation, simple dehiscence, eviscerationare included in the global package for the surgery.
However, depending [...]
