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Underlying condition-Global Period

  1. Unhappy Underlying condition-Global Period
    Medical Coding Books
    I got my employers attention when I told her about global periods in the ER. They were only using global periods for major surgeries. I showed her there are global periods for minor procedures done in the ER also. Now there is a new delema. I printed the definition for global periods from the CMS website. There was a part in it that says "Treatment for the underlying condition"or an added course of treatment which is not a part of normal recovery from surgery is not included in the global period". So now they are saying if someone comes into the ER and has an abcess and the Dr performs and incision and drainage 10061 (which has a 10 day global period) and if the pt comes back in 2 days and the Dr is treating the infection then it is not included and I should code an E/M level, because he is treating the "underlying condition" which is the infection. I don't think that is correct. Can anyone help me!!??
    Last edited by ness01; 02-25-2009 at 06:06 PM.

  2. #2
    North Carolina
    CPT guidelines vary slightly from Medicare.

    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 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.

    You would need to check with your carriers to see what guidelines they follow. But as a rule of thumb, if it's not Medicare...we attempt to collect.
    Rebecca CPC, CPMA, CEMC

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