Global surgery - pre operative or post operative period

Global Surgery Policy

Global surgery includes all necessary services normally furnished by a surgeon before, during, and after the procedure. Payment for the surgical procedure includes the preoperative, intraoperative, and postoperative services routinely performed by the surgeon. The global surgery concept is defined as a nationwide equitable payment under the Medicare fee schedule to uniformly administer payment for surgical and related services.

Surgeries are classified into two different categories: major and minor. The global surgery policy ap- plies to both major and minor surgical procedures as defined by their postoperative periods. The global surgery policy applies to surgical procedures for which there are postoperative periods of 0, 10, and 90 days.

Minor surgery is a relatively simple surgical service that involves a readily identifiable surgical pro- cedure and includes variable intraoperative and postoperative services. Minor surgeries have a post- operative period of either 0 or 10 days.

Major surgery is a relatively intense surgical service that involves a readily identifiable surgical pro- cedure and includes variable preoperative, intraoperative, and postoperative services. Major surgeries are further identified by their postoperative period. All major surgical procedures have a 90-day postoperative period that begins immediately following the day of surgery and a 1-day preoperative period. The global period for major surgeries includes the pre- and postoperative periods and the day of surgery.

GLOBAL SURGERY PERIOD

Louisiana Medicaid’s global surgery period (GSP) policy differs from Louisiana Medicare policy.

• Medicaid does not pay for the day before, the day of, and the assigned GSP after surgery. Louisiana Medicaid assigns a GSP 1, 10, or 90 days. If you look at the Professional Fee Schedule, the Global Surgery Period can be found in column 11.

• If a procedure has a GSP of “1”, the provider cannot bill for an evaluation and management service (E/M) the day before or the day of the procedure.

• If a procedure has a GSP of “10”, the provider cannot bill for an E/M service the day before, the day of, or 10 days following the procedure.

• If a procedure has a GSP of “90”, the provider cannot bill for an E/M service the day before, the day of, or 90 days following the procedure.

• Error code 690 (payment included in surgery fee) results when an E/M service is denied for a date of service within the GSP of the surgery or procedure that has been paid.

• Error code 691 (visit paid in GSP; void visit, rebill surgery) results when a surgery or procedure is denied because an E/M service has been paid for a date of service within the GSP of the surgery or procedure. The paid claim for the E/M service must be voided before the claim for the surgery or procedure can be considered for payment. 


• E/M services should be billed separately only if the diagnosis and service rendered are unrelated to the diagnosis of the GSP procedure. If a visit is to be billed for a date of service within the GSP for unrelated diagnosis, it should be filed on a claim form separate from that of the GSP surgery or procedure. 

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