Surgical billing modifier codes

Surgical Modifiers

Global Surgery

Surgeons have traditionally provided a “ Global Package ” of care. Under this concept , surgeons bill a single fee for all services usually associated with the surgery. The implementation of the Medicare fee schedule under physician payment reform requires all Medicare Carriers to adopt uniform payment policies, including a uniform global surgical package. This means Medicare payments for a given surgical procedure will be the same for the same package of care, regardless of which Carrier makes the payment.

The Medicare approved amount for these major surgeries includes payment for the following services related to the surgery when furnished by the physician who performs the surgery. The services included in the global surgical package may be furnished in any setting, e.g., in hospitals, ASCs, physicians ’ offices. Visits to a patient in an intensive care or critical care unit are also included if made by the surgeon. However, critical
care services (99291 and 99292) are payable separately in some situations.

Preoperative Visit

A preoperative visit is considered as the day before or day of surgery for major procedures and the day of surgery for minor procedures. It is included in the global package, unless it generates the decision for major surgery (57 modifier), or is separately identifiable for minor surgery (25 modifier).

Postoperative Visits

Follow-up visits during the postoperative period of the surgery that are related to recovery from the surgery are included in the global payment. If the visit is not related to the recovery, then file with the 24 modifier and list the new complaint as the primary diagnosis for the visit.

CPT modifiers for surgical billing

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