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Payers may not reimburse for procedures or services within physician's global period

APCs Weekly Monitor, January 16, 2009

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Q. We are having a problem with facility E/M billing during the postoperative global period at our facility. I found the following ruling regarding facility postoperative care during the physician surgical global period in the Federal Register (18448 Federal Register / Vol. 65, No. 68 / April 7, 2000 / Rules and Regulations):

For now, hospitals are to bill follow-up care, such as suture removal, using an appropriate medical visit code. We did not propose, nor have we included in this final rule with comment period, provision for a global period for hospital outpatient services analogous to the global period affecting payments for professional services made under the Medicare physician fee schedule.

Although this information is from April 2000, I have searched but have not found an update to this rule. Is this rule still correct, or have there been any updates or changes since 2000?

A. This information is still correct. CMS bases OPPS reimbursement on individual services for individual dates of service, and the global period is not applicable. However, consider what the quoted guidance says about providing a service in a hospital setting within the physician’s surgical global period.

Many payers will not reimburse a facility for a procedure or service that is part of the physician’s global service period. Because this is a payer-specific situation, you should check with your FI or MAC, or other payers, about the reasons for the difficulties you are experiencing.

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