October 5, 2017
When coding for surgical procedures, it's important to understand the definition of the “global period” of the original surgery.
A global surgery or a global surgical package starts on either the day of the surgical procedure or the day before. The end time of the global surgery/global surgical package is determined by whether the procedure is classified as major or minor. Any surgeries rendered during this global period are considered part of the original surgical procedure.
Sometimes it's necessary to bring the patient back to the operating room (OR) for another surgical procedure, such as a pre-determined staged procedure, a repeat procedure, an unplanned procedure, or an unrelated procedure.
These services must be submitted with a correct modifier identifying the circumstances for the return to the OR. If the procedure is truly a separate and distinct service and not part of the original surgical procedure, one of the following modifiers must be appended to the procedure code:
- Modifier 58 - Staged Procedure during Global Period
This modifier indicates the physician who performed the original surgery prospectively planned to return the patient to the operating room for an additional surgery during original surgery's global period. Don't append this modifier to any procedure whose description already indicates multiple sessions or procedures.
- Modifier 78 - Unplanned Return to the Operating Room for Related Procedure During the Global Period
This modifier indicates an unplanned return to the operating room for either treatment for complications related to the original surgery or a surgery related to the original surgery that started the global period. The decision to return a patient to the operating room is made by the same physician who conducted the original surgery.
- Modifier 79 - Unrelated Surgical Procedure During the Global Period
This modifier indicates that the provider who performed the original surgery performed an additional procedure or service during the global period. The additional procedure or service is unrelated to the original procedure, typically involving a different anatomic location.
Services
If services take place during the global period of another surgical procedure, and you submit them without a modifier, we'll deny reimbursement.
Review the Global Surgery payment policy for further details on billing services within a global surgery period.