CPT's Surgical Package
According to CPT, the surgical package includes the following:
The surgical procedure; Local infiltration, metacarpal/ metatarsal/digital block or topical anesthesia;One related evaluation and management (E/M) encounter (including history and physical) that occurs after the decision for surgery has been made and is either on the date immediately prior to the procedure or on the actual date of the procedure;Immediate postoperative care, including dictating operative notes and talking with the family and other physicians;Writing orders;Evaluating the patient in the postanesthesia recovery area;Typical postoperative follow-up care.
CPT states that "typical postoperative follow-up care" includes only that care which is usually a part of the surgical service. Complications, exacerbations, recurrence, or the presence of other diseases or injuries requiring additional services should be separately reported. This means that, from a CPT perspective, the global surgical period extends from no more than one day before the day of the procedure to as long as is necessary for typical postoperative follow-up care to be completed. In essence, the postoperative period is open-ended.
Medicare's View
As is common, Medicare's rules differ slightly from that of CPT. Section 4821 of the Medicare Carriers Manual (available online at cms.hhs.gov/manuals/14_car/3b4820.asp#_1_2) provides a definition of Medicare's global surgical package. Many other payers use this as a model. From a Medicare perspective, surgical procedures include the following services when furnished by the physician who performs the surgery:
Preoperative visits after the decision is made to operate beginning with the day before the day of surgery for major procedures and the day of surgery for minor procedures;Intraoperative services that are a usual and necessary part of a surgical procedure;All additional medical or surgical services required of the physicianduring the postoperative period of the surgery because of complications not requiring additional trips to the operating room;Follow-up visits during the postoperative period of the surgery that are related to recovery from the surgery;Postsurgical pain management;
Certain supplies;Miscellaneous services (e.g., dressing changes; local incision care; removal of operative packs; removal of cutaneous sutures and staples, lines, wires, tubes, drains, casts and splints; insertion, irrigation and removal of urinary catheters, routine peripheral intravenous lines, nasogastric and rectal tubes; and changes and removal of tracheostomy tubes).
Note a couple of distinctions between the Medicare and CPT package: First, unlike CPT, Medicare includes in the surgical package treatment of complications that do not require additional trips to the operating room. Second, unlike CPT, the postoperative part of Medicare's global period is not open-ended. Medicare assigns postoperative global periods of 90 days to major surgeries and either zero or 10 days to minor surgeries and endoscopies. Any services beyond the Medicare postoperative global period, even if related to the procedure, are separately report able. If you have any questions about the length of the postoperative global period assigned to a given code, you can find it in the Medicare Physician Fee Schedule database.
Now...I'm not sure I understand what you mean by agreement. When you say "company"...is this the hospital, insurance company...(?) Aren't you receiving denials for these services that should be included in the "global package"? Can you expand on an actual patient scenario?