Wiki Global Package for Surgery Done in the Office

[Lynne77]

Hello!

We performed a surgery (complex repair) on a patient in the office that has a global period of 90 days. The patient had a complication and had to come back for another procedure during the global period. Per payer policy, "Treatment for post-operative complications requiring a return trip to the Operating Room (OR). An OR, for this purpose, is defined as a place of service specifically equipped and staffed for the sole purpose of performing procedures. The term includes a cardiac catheterization suite, a laser suite, and an endoscopy suite. It does not include a patient’s room, a minor treatment room, a recovery room, or an intensive care unit (unless the patient’s condition was so critical there would be insufficient time for transportation to an OR)" is not included in the global package. My question is, does the term "operating room" here include the office (aka, can we add modifier 78 to get this paid)? I realize it says it doesn't include a patient or minor treatment room, so I'm pretty sure the answer is no; however, to me, it doesn't make sense that the office is an acceptable operating room for the original procedure, but does not qualify as an "operating room" for the treatment of the complication.

Thanks!

 

[thomas7331]

You're correct, an office is not an OR. That the original procedure was done in an office isn't really relevant though - regardless of where it was done, any kind of related follow-up care in the office is part of the reimbursement. Only a complication that requires the provider to take the patient into the OR will fall outside of the original payment.

 

[Lynne77]

Thanks so much for the confirmation!