Neurology & Pain Management Coding Alert

Question: What's the difference between an XXX global period and a 000 global period?

Indiana Subscriber 

Answer: Although both XXX and 000 global periods (as designated in the Medicare Fee Schedule Database) appear to be free of global bundling issues, there is a distinct difference between the two.
 
The classification XXX (Global surgical rules do not apply) means that the service is truly free of global surgical bundling issues, and you can separately report services that you perform on the same date as the surgical procedure (such as E/M services).
 
The 000 indicator applies to the date of the procedure only. Medicare will therefore bundle all E/M services that the neurologist performs on the procedure date into codes with this indicator.
 
For instance, trigger point injections (for example, 20550*, Injection[s]; tendon sheath, ligament) include a 000 global period. This means that if the neurologist performs an E/M service on the same date as the injection, Medicare will bundle the E/M into payment for 20550 (unless, of course, the physician provides the E/M service for a significant, unrelated problem. In this case, you may report the E/M separately and append modifier -25, Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service).
 
Electrodiagnostic tests, such as nerve conduction studies (for example, 95900, Nerve conduction, amplitude and latency/velocity study, each nerve; motor, without F-wave study), typically include an XXX global period. If the physician provides a related consult on the same day he or she conducts an NCS, Medicare should not attempt to bundle payment for the consult into 95900 because the XXX global period applies.