The Global Surgery Package generally includes three phases of care:

• Preoperative Care: This includes all related visits and services provided to the patient before the surgery, such as evaluations, examinations, and consultations related to preparing the patient for surgery.
• Intraoperative Care: The actual surgical procedure itself, including all necessary operative techniques, use of equipment, and anesthesia.
• Postoperative Care: Any follow-up visits, routine care, and treatments provided to the patient after the surgery. The length of postoperative care covered under the GSP depends on the global period, which can be 0, 10, or 90 days based on the complexity of the procedure.

Global Periods and Their Importance

The global period is the time frame during which all routine postoperative care is bundled into the initial surgery payment. There are generally three types of global periods:

• 0-Day Global Period: Covers only the day of the surgery, without additional postoperative care included. Any services provided beyond the day of the surgery are billed separately.
• 10-Day Global Period: Includes the surgery day and 10 days of postoperative care. It generally applies to minor procedures.
• 90-Day Global Period: Encompasses the day of surgery and 90 days of postoperative care. It is typically assigned to major surgeries requiring extended recovery and follow-up.

Understanding the global period assigned to a surgical procedure is crucial for coders, as it determines which services are bundled into the initial surgery payment and which need to be coded separately.

What’s Included and Not Included in the GSP

The Global Surgery Package covers a variety of services that are considered part of the surgical care, including:

• Routine Preoperative Visits: Any office visits or assessments prior to surgery that are related to the procedure.
• Intraoperative Services: All services performed during the surgery itself, including the use of anesthesia and any surgical techniques or devices.
• Standard Postoperative Care: Follow-up office visits, wound checks, and any routine postoperative care within the defined global period.

However, not all services are included in the GSP. Coders must separately code and bill for services such as:

• Unrelated Visits or Procedures: Any medical services not related to the surgery, like treatment for an unrelated condition, must be coded separately.
• Complications Requiring Additional Surgery: If a complication arises and an additional surgery or procedure is needed beyond the usual scope of the original surgery, these must be billed separately.
• Diagnostic Tests and Treatments Beyond Routine Postoperative Care: Any specialized diagnostic tests or additional treatments that are not part of the standard postoperative care fall outside the GSP.

Using Modifiers for Services Outside the Global Package: Coders use modifiers to indicate services that are not part of the global package. For example, modifier -24 is used to document an unrelated evaluation and management service during the global period, while modifier -78 may indicate an unplanned return to the operating room.

How the GSP Affects Billing and Reimbursement

The Global Surgery Package streamlines billing by bundling related services into one payment, reducing the need for multiple claims and simplifying the reimbursement process. However, for coders, it requires a clear understanding of which services are bundled into the package and which are not.

Accurate coding is essential for avoiding overbilling or underbilling. If coders mistakenly bill for services that are part of the GSP, this can lead to denials and delays in payment. Conversely, failing to bill for services that are not included in the package can result in lost revenue.

Understanding Payer Policies: Each payer, including Medicare, has specific rules regarding the GSP. Coders must be aware of payer-specific policies, as these determine which services are covered under the GSP, how global periods are defined, and any exceptions to standard rules.

The Global Surgery Package is an essential aspect of surgical coding and billing, providing a comprehensive framework for bundling preoperative, intraoperative, and postoperative services. By understanding the GSP, coders and billing specialists can ensure accurate documentation, appropriate reimbursement, and compliance with payer policies. Properly applying the global period, knowing which services are bundled or excluded, and using modifiers correctly are key to mastering the GSP and ensuring the financial health of surgical practices and healthcare facilities.