Global SurgeryGlobal Surgery
K&N PMCCK&N PMCC
 To better understand the application of
modifiers, it is necessary to understand
a little about the “global surgical
pac...
CPT Surgical PackageCPT Surgical Package
 Defined as included in a given CPT
surgical code, the following services are
al...
Surgical PackageSurgical Package
 Medicare adopted the global surgical package
as part of the Medicare Physician Payment
...
Surgery Global PeriodSurgery Global Period
00
00 1010
00 1010 2020 3030 4040 5050 6060 7070 8080 9090
MinorMinor
MajorMajo...
Surgery Global PeriodSurgery Global Period
00
00 1010
00 1010 2020 3030 4040 5050 6060 7070 8080 9090
MinorMinor
MajorMajo...
Components of CMS Surgical PackageComponents of CMS Surgical Package
Pre-opPre-op
VisitVisit
Intra-opIntra-op
ServicesServ...
ServicesServices NOTNOT IncludedIncluded
Return toReturn to
OR for compOR for comp
TransplantTransplant
Immuno-Immuno-
sup...
Modifier 25Modifier 25
 Significant, separately identifiable
evaluation and management service by
the same physician on t...
Modifier 25Modifier 25
 The E/M service may be prompted by
the symptom or condition for which the
procedure and/or servic...
Modifier 57Modifier 57
 Decision for surgery
 An E/M service that resulted in the initial
decision to perform the major ...
Modifier 57Modifier 57
 Should be appended to an E/M code
only when that E/M service represents
the initial decision to p...
ModifiersModifiers
 Remember this statement?
 All pre-operative visits performed by the
surgeon, which occur the day of ...
ModifiersModifiers
 Remember this statement?
 Post-operative services that include all
uncomplicated follow-up care
 Ho...
ExampleExample
 Dr. Green sees Mrs. Johnson, a new
patient, for a pain in her right knee. After
an expanded problem focus...
ExampleExample
 Tommy Smith presents to Dr. Green’s
office complaining of nausea and lower
left quadrant abdominal pain. ...
Thank YouThank You
Sources:
AMA CPT Manual
CMS
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Glogal surgery workshop

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Glogal surgery workshop

  1. 1. Global SurgeryGlobal Surgery K&N PMCCK&N PMCC
  2. 2.  To better understand the application of modifiers, it is necessary to understand a little about the “global surgical package”  Current Procedural Terminology (CPT) states: “The CPT codes that represent a readily identifiable surgical procedure thereby include, on a procedure-by- procedure basis, a variety of services.”
  3. 3. CPT Surgical PackageCPT Surgical Package  Defined as included in a given CPT surgical code, the following services are always included in addition to the operation per se:  Local, digital block, or topical anesthesia  One E/M encounter the day before or day of surgery (including history and physical)  Immediate postoperative care  Writing orders  Evaluating patient in the postanesthesia recovery area  Uncomplicated follow-up care
  4. 4. Surgical PackageSurgical Package  Medicare adopted the global surgical package as part of the Medicare Physician Payment Reform  They defined what they consider “inclusive” as  All pre-operative visits performed by the surgeon, which occur the day of or one day prior to the surgery  Intra-operative services by the surgeon  Post-operative services that include all uncomplicated follow-up care  They also define the postoperative time frame.  000, 010, 090 indicating the number of days  0-10 Minor  90 Major
  5. 5. Surgery Global PeriodSurgery Global Period 00 00 1010 00 1010 2020 3030 4040 5050 6060 7070 8080 9090 MinorMinor MajorMajor MinorMinor Medicare classifies surgical procedures asMedicare classifies surgical procedures as “major” or “minor”“major” or “minor” Global surgeries have eitherGlobal surgeries have either 0, 100, 10 oror 9090 daysdays applied to the particular procedureapplied to the particular procedure
  6. 6. Surgery Global PeriodSurgery Global Period 00 00 1010 00 1010 2020 3030 4040 5050 6060 7070 8080 9090 MinorMinor MajorMajor MinorMinor Example ofExample of 9090 day Global Period:day Global Period: Date of surgery –Date of surgery – January 5January 5 Preoperative period –Preoperative period – January 4January 4 Last day of postoperative period –Last day of postoperative period – April 5April 5
  7. 7. Components of CMS Surgical PackageComponents of CMS Surgical Package Pre-opPre-op VisitVisit Intra-opIntra-op ServicesServices Post-opPost-op VisitsVisits Misc.Misc. ServicesServices GlobalGlobal SurgerySurgery Post Surgical Pain Mgt Complications SuppliesSupplies
  8. 8. ServicesServices NOTNOT IncludedIncluded Return toReturn to OR for compOR for comp TransplantTransplant Immuno-Immuno- suppresivesuppresive TherapyTherapy UnrelatedUnrelated Post-opPost-op VisitsVisits InitialInitial ConsultationConsultation or Evaluationor Evaluation Critical CareCritical Care MoreMore ExtensiveExtensive ProcedureProcedure Dx Tests orDx Tests or ProcedureProcedure AddedAdded CourseCourse ofof TreatmentTreatment Non-RelatedNon-Related ProcedureProcedure
  9. 9. Modifier 25Modifier 25  Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service
  10. 10. Modifier 25Modifier 25  The E/M service may be prompted by the symptom or condition for which the procedure and/or service was provided. As such, different diagnoses are not required for reporting of the E/M service  This modifier is not used to report an E/M service that resulted in a decision to perform surgery
  11. 11. Modifier 57Modifier 57  Decision for surgery  An E/M service that resulted in the initial decision to perform the major surgery may be identified by adding modifier 57 to the appropriate level of E/M service
  12. 12. Modifier 57Modifier 57  Should be appended to an E/M code only when that E/M service represents the initial decision to perform a major surgical procedure  A major surgical procedure is defined by CMS as a procedure having a ____ day global period assigned by CMS 9090
  13. 13. ModifiersModifiers  Remember this statement?  All pre-operative visits performed by the surgeon, which occur the day of or one day prior to the surgery.  How can we identify a per-operative service as separate? Modifier 25 Modifier 57 What’s the difference? Minor Major
  14. 14. ModifiersModifiers  Remember this statement?  Post-operative services that include all uncomplicated follow-up care  How can we identify a post-operative service as separate? Modifier 24 Modifier 78 Modifier 58
  15. 15. ExampleExample  Dr. Green sees Mrs. Johnson, a new patient, for a pain in her right knee. After an expanded problem focused history, detailed examination and low medical decision making, Dr. Green decides to inject Mrs. Johnson’s right knee with 40mg Depo-Medrol. Visit code? Procedure? Other? 99202- New Patient - Level 299202- New Patient - Level 2 20610-RT Injection; major joint or bursa20610-RT Injection; major joint or bursa J1030 Depo-Medrol, 40 mgJ1030 Depo-Medrol, 40 mg 2525
  16. 16. ExampleExample  Tommy Smith presents to Dr. Green’s office complaining of nausea and lower left quadrant abdominal pain. Dr. green performs a new patient comprehensive history and examination, moderate medical decision making, and decides Tommy has appendicitis. He sends him to the hospital, where he will perform surgery. Visit code? Modifier? 99204- New Patient - Level 499204- New Patient - Level 45757
  17. 17. Thank YouThank You Sources: AMA CPT Manual CMS

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