Surgery is so much more than just the procedure. The role of surgical global periods in billing services can create a distinction in how medical professionals bill for services. Knowledge of these intervals (as well as the rules surrounding billing) aids in the proper reimbursement and compliance with healthcare regulations.
What Are Surgical Global Periods?
Surgical global periods encompass all components related to the surgery as a single package. This includes before, during, and after the surgery. The time taken can vary depending on the nature of the procedure. These periods are typically divided into three groups: 0-day, 10-day, and 90-day. A global surgery calculator is a tool that is immensely useful to understand these components better.
Zero-Day Global Period
If a procedure has a zero-day global period, then care occurs on the same day as the surgery. Any follow-up is billed separately. These typically include minor surgeries or diagnostic tests. Understanding what a zero-day service actually means helps ensure accurate billing.
Ten-Day Global Period
Minor surgeries that need a limited bit of follow-up will have a ten-day global period. The day of the surgery is included in this period, which lasts for ten days afterward. Any routine postoperative care is not separately billable during this time. However, at the same time, any additional procedures or complications are optional.
Ninety-Day Global Period
Substantial surgical procedures are also generally in a ninety-day global period. This long time span begins on the day of the procedure and lasts for a considerable period. All routine follow-up care within this time period is included in the package. Understanding the limits will ensure you don’t charge for something you’re not able to bill for.
Billing Rules and Considerations
To bill accurately during surgical global periods, apply specific rules. Each type of period has its unique considerations, which affect how you bill your services.
Preoperative Visits
Preoperative visits are often bundled into the global package if performed within one day of surgery. These are vital for discussing the procedure, reassuring patients, and conducting any necessary tests. Proper documentation of these visits is essential to staying compliant.
Postoperative Care
Part of the global package includes routine postoperative care. This includes follow-up appointments as well as surgical treatment, where necessary. Separately, additional procedures may be billed in the event of complications. Every visit must be well-documented, as this is necessary to justify any exemption from the package.
Unrelated Services
Other services not directly related to the surgery may be billed separately. So, if a patient needs treatment for another ailment, they are not within the global period. These services should be separated out through good code and documentation.
Modifiers and Their Importance
Knowing how modifiers impact the billing process is key. They add detail and context to services rendered and help ensure a claim is successful.
Common Modifiers Used
The list below includes some common modifiers in surgical billing.
Modifier 24: Unrelated evaluation and management service during the postoperative period. Modifier 25: Significant and separately identifiable evaluation and management service performed by the same physician on the same day as a procedure.
Modifier 79: Unrelated procedure during the postoperative period.
Accurate Use of Modifiers
By applying these modifiers correctly, you can avoid claim delays. Misapplying modifiers can result in claim denials or audits. Educating staff about correct modifier usage can help avoid these challenges and develop a more efficient billing workflow.
Documentation: A Key Component
Documentation plays a vital role in the surgical billing process. It gives a comprehensive record of the patient’s care, and it serves the purpose of the billing process.
Importance of Detailed Records
Well-documented records are crucial for defending the billed services. It should have detailed notes regarding the appointment, the procedure performed at that time, and any complications. This documentation provides assurance on the use of modifiers and also describes the number of procedures required for additional services.
Training and Compliance
It is essential that employee training includes documentation standards and compliance regulations. It guarantees all records comply with the law and facilitates proper billing. Conduct regular audits and reviews to determine where improvements are needed.
Final Thoughts
Surgical global periods and billing rules are important to understand for providers. Accuracy is key; billing is only effective if it is accurate, in accordance with regulations, and results in appropriate reimbursement for services. Having a command of these will allow healthcare professionals to focus their attention on quality treatment while ensuring their invoicing remains intact as well.
