Health Information Management

Understand how to report services during the global period for minor surgeries

JustCoding News: Outpatient, February 10, 2010

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by Dawson Ballard Jr., CCS-P, CPC

Navigating the waters of the 10-day global period for minor surgeries can be a headache for providers and coders alike. Even more frustrating is trying to understand what codes to report for services provided during the global period. The first step to coding correctly is to recognize whether the 10-day global period applies, and if so what is included.

Although most minor surgical procedures (e.g., laceration repairs, skin tag removals) have a 10-day global period, it is important that providers and coders verify that information. You can do so by referencing Field 16 on the CMS Medicare Fee Schedule Data Base. If the 10-day global period applies to the minor procedure, the entry “010” will appear in Field 16.

If the procedure has a 10-day global period, most carriers will not reimburse for any postoperative follow-up visits related to the procedure that occur during those 10 days. This includes visits for such things as removal of stitches or sutures, any incisional care, or dressing changes.

Coding for services during the global period

Now let’s look at how to code for services physicians provide during the 10-day global period. Coders may refer to code 99024 (Postoperative follow-up visit, normally included in the surgical package, to indicate that an evaluation and management [E/M] service was performed during a postoperative period for a reason(s) related to the original procedure) in the CPT® Manual in the Medicine section to report postoperative visits during the global period. Although these visits are included in the surgical package, the AMA created this code so providers could use it as a tracking mechanism and enter it into their electronic medical records system as a procedure code to go along with the note for that visit.

Only use this code for visits that occur during the 10-day global period. When a patient has a postoperative visit after the global period related to the original procedure, report the appropriate CPT code(s) for that encounter instead of code 99024.

For example, a patient presents to the office for a check of a wound that the physician repaired three days earlier. It’s appropriate to report code 99024 for this encounter because the follow-up occurred within the 10-day global period.

Reporting unrelated visits during the global period

One common question coders have is how to report any visits or procedures the patient may have during the global period that are unrelated to the original procedure. The AMA created two modifiers to help simplify the reporting of these circumstances.

The first is modifier -79, which indicates the same physician performed a procedure or service unrelated to the original procedure during the postoperative period. Note that a new postoperative period begins once the physician performs the unrelated procedure.

The second is modifier -24, which indicates that the same physician performed an unrelated E/M service during the postoperative period. CMS states in the Medicare Claims Processing Manual, chapter 12 that the documentation must show that the E/M visit was unrelated to the original surgery. Supporting documentation would include diagnosis codes that show the visit was unrelated to the original procedure. Let’s look at two examples to illustrate this guidance.

Example 1
On Monday, a physician removes a patient’s skin tag. Three days later, the patient presents to the office for an excision of a 0.9 cm benign lesion on his or her left arm.

For this second encounter, you should report code 11402-LT (Excision, benign lesion including margins, except skin tag [unless listed elsewhere], trunk, arms or legs; excised diameter 0.6 to 1.0 cm) and append modifier -79 to indicate that the lesion excision, which the physician performed during the global period for the skin tag removal, was unrelated to that original procedure.

Example 2
A patient presents to the office three days post-op for a wound check following a laceration repair to his or her left hand. During the wound check, the patient complains of cold symptoms. The physician performs and documents an expanded problem-focused history and exam and diagnoses the patient with an acute upper respiratory infection (URI).

For this second encounter, report code 99213-24, -25, and code 99024.

Modifier 24 indicates that the E/M service related to the URI was unrelated to the laceration repair. Appending modifier -25 to the E/M code indicates that the E/M service was a significant, separately identifiable service that the physician performed on the same day as the wound check. Code 99024 indicates that the wound check for the laceration repair occurred during the 10-day global period.

Coding for postoperative complications

Another question with which providers and coders often struggle is how to code for complications that the patient may experience during the global period related to the procedure. The CPT Manual states in the surgery guidelines section that any complications, exacerbations, recurrence, or presence of other diseases requiring additional services are not included in the global period, so coders may report them separately.

For example, when a physician performs a laceration repair on a patient’s right finger and then the wound becomes infected during 10-day global period, CPT guidelines state that all care that the provider performs related to the infection is not included in the global period and coders can report them separately.

However, it’s important to note that CMS takes a different approach in this case. Per the Claims Processing Manual, chapter 12, any complications that develop during the global period related to the procedure are part of the global unless the patient returns to the operating room.

So for the scenario regarding the patient’s infected finger wound following the laceration repair, the provider would not be able to report the complication, according to CMS guidelines. It would be part of the global period. Thus report code 99024 unless the physician performs a related procedure on the patient.

Following these guidelines can help make navigation through the 10-day global period a smoother ride.

Editor’s note: Dawson Ballard Jr., CCS-P, CPC, is the coding educator with Take Care Health Systems in Franklin, TN. E-mail him at dawson.ballard@takecarehealth.com.



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