Cracking the Code
Services Included in the Surgical Package
Medicare has classified major and minor surgeries and has determined what services are included and not included with the global package. Medicare also determined the preoperative and postoperative days allowed for each type of surgery.
The preoperative period included in the global fee for major surgery is 1 day with 90 days for the postoperative period. The preoperative period for minor surgery is the day of the procedure with a postoperative period of either 0 or 10 days, depending on the procedure. For endoscopic procedures (except procedures requiring an incision), there is no postoperative period. Global period days are available on the CMS website.
Each CPT code also has a global period status indicator, as per CMS payment policies. Surgical CPT codes (10021–69999) have a global surgery status indicator determining classification for a minor or major surgery as determined by RVU calculations. Per the Federal Register, Vol. 74, No. 132, surgical status indicators are assigned based on risk factors associated with medical specialties.
When we are navigating through coding surgical procedures, it is always important to know what is and is not included in the global package.
What is included in the global package?
- Preoperative Visits—Preoperative visits on the day before or the day of a major procedure, and pre-operatives performed on the day of a minor procedure
- Intraoperative Services—Intraoperative services are considered a usual and necessary part of a surgical procedure, such as the use of local infiltration, metacarpal/metatarsal/digital block, or topical anesthesia
- Complications Following Surgery—All additional medical or surgical services required of the surgeon during the postoperative period of the surgery because of complications, which do not require additional trips to the operating room
- Postoperative Visits—Follow-up visits within the postoperative period of the surgery, related to recovery from the surgery
- Postsurgical Pain Management—By the surgeon
- Miscellaneous Services—Items such as dressing changes; local incisional care; removal of operative pack, 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