What is the Global Period in Medical Billing

The health care industry serves thousands of Medicare patients regularly. Some of these patients are treated using non-surgical procedures while others are required to undergo surgical procedures depending on the severity of the illness. The patients who are required to undergo surgery are likely to stay in the hospital for a few days considering the intensity of the procedure and the time of recovery. In such cases, the payment is made based on the global period. However, one cannot comprehend the global period and its role in medical billing without understanding the term global surgery as they both are interlinked.

Definition of Global Surgery (or Global Surgical Package)

The Centers for Medicare & Medicaid Services (CMS) defines Global Surgery as a field that “provides the postoperative time frames that apply to payment for each surgical procedure or another indicator that describes the applicability of the global concept to the service”.

Based on the phrase ‘time frames’ in the definition of Global Surgery, we may define the global period as a time that begins with a surgical procedure and ends a few days after the surgical procedure. So, in simple words, the global period covers the length of a patient’s hospital stay during postoperative care.

Phases of Global Surgery

In the Global Surgery is divided into three phases:

• Preoperative evaluation
• Intraoperative procedure
• Postoperative care

The Postoperative Care (Global Period)

As mentioned earlier the global period covers a patient’s stay in hospital postoperative. Based on the coverage of the post-operative time frame the global period is divided into three phases—zero-days, ten days, and ninety days.

At present, the values used by CMS as global surgery indicators given in the CMS National Physician Fee Schedule Relative Value Files are—000, 010, 090, MMM, XXX, YYY, and ZZZ as given in the document
https://www.cms.gov/apps/physician-fee-schedule/help/How_to_MPFS_Booklet_ICN901344.pdf

• 000: “Endoscopic or minor procedure with related preoperative and postoperative relative values on the day of the procedure only included in the fee schedule payment amount; evaluation and management services on the same day of the procedure generally not payable.”
• 010: “Minor procedure with preoperative relative values on the day of the procedure and postoperative relative values during a 10-day postoperative period included in the fee schedule amount; evaluation and management services on the day of the procedure and during this 10-day postoperative period generally not payable.”
• 090: “Major surgery with a 1-day preoperative period and the 90-day postoperative period included in the fee schedule payment amount.”
• MMM: “Maternity codes; usual global period does not apply.”
• XXX: “Global concept does not apply.”
• YYY: “MAC determines whether global concept applies and establishes postoperative period, if appropriate, at time of pricing.”
• ZZZ: “Code related to another service and is always included in the global period of the other service. (Note: Physician work is associated with intra-service time and in some instances the post-service time.)”

The medical biller is trained to generate a bill for the global surgical package using appropriate surgical codes and modifiers. This ensures maximum reimbursement for the global period by eliminating any delay in payments.