November 7, 2019
After an initial surgery has been performed, all subsequent office visits and surgeries are part of the initial surgery’s global period unless coded to indicate unrelated circumstances or a staged procedure. Failure to code the subsequent office visits and surgeries correctly will result in a denial of reimbursement.
Premera follows the global days criteria established in the CMS National Physician Fee Schedule Relative Value File. Every code in the CMS fee schedule has one of the following global days indicators:
- 000 days = Endoscopic or minor procedure with related pre-operative and post-operative services
- 010 days = Minor procedure with pre-operative period on the day of the procedure and 10-day post-operative period
- 090 days = Major surgery with a 1-day pre-operative period and 90-day post-operative period
- MMM = Maternity codes - (NOTE: Premera has established specific day periods for codes in this category)
- XXX = Global concept does not apply
- YYY = Carrier determination as to whether concept applies
- ZZZ = Code is related to another service and always included in the other service (ie: Add-on codes)
For more information on global surgery, global days indicators of what is and is not in the global surgery payment, and how to bill subsequent office visits and surgeries occurring in the global surgery period, review the following payment policies:
The CMS national physician fee schedule can be found at the CMS National Physician Fee Schedule Relative Value File. Select the specific year and quarterly RVU file to find the global days indicators by code.