What is NOT Included in the Global Package

Don’t lose out on revenue due to a misunderstanding of what you are allowed to bill that is not included in the global surgery payment. There are many services that may be billed and paid for separately.

NOTE: The initial evaluation for minor surgical procedures and endoscopies are included in the global surgery package. 

Services not included in the global package, which can be billed for separately, include:

• The initial consultation or evaluation to determine the need for the surgery;
• Appending a modifier 57 (Decision for Surgery), can ensure reimbursement.

• Visits by the same physician on the same day as the surgery or endoscopy are included in the global package;
• If there is an entirely separate encounter for evaluation and management you may bill the visit with Modifier 25.

• Services of other physicians related to the surgery, except where the surgeon and the other physician(s) agree on the transfer of care. This agreement may be in the form of a letter or an annotation in the discharge summary, hospital record, or ASC record.

• Visits unrelated to the diagnosis for which the surgical procedure is performed, unless the visits occur due to complications of the surgery.

• Treatment for the underlying condition or an added course of treatment which is not part of normal recovery from surgery.

• Diagnostic tests and procedures, including diagnostic radiological procedures;

• Clearly distinct surgical procedures that occur during the post-operative period which are not re-operations or treatment for complications.

• 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).

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