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November 9, 2012

Submitting Surgery Modifiers within a Global Surgery Period

The CMS global surgery package defines the services included in a surgical payment as well as services that are excluded from (and that may be reimbursed in addition to) the surgical payment. All services rendered in the surgery global period are subject to the surgery package guidelines. There may be exceptions to the global surgery package; in these cases, submit the service (which would otherwise be included in the package) with the appropriate modifier to denote the exception. In all cases, supporting documentation to support the use of these modifiers must be maintained in the patient’s medical record.

For surgical services, the two most common exceptions to the global surgery package are:

  • Returning to the operating room for a related procedure during the global surgery period
  • Performing an unrelated surgical procedure during the global surgery period of the initial surgery

Global Surgery Modifiers submitted during the global period are defined in the AMA CPT® manual.

CPT Modifier Description Tips
78 Unplanned Return to the Operating or Procedure Room by the Same Physician following Initial Procedure for a Related Procedure during the Post-operative Period.
  • Submit only with surgery services
  • An ICD-9 code unrelated to the reason for surgery may be sufficient documentation with the claim
  • If the second surgery was planned, see CPT modifier 58
  • If the service was part of the initial surgery, do not submit a separate claim (the surgery is included in the global payment)
79 Unrelated procedure or service by the same physician during a post-operative period
  • Submit only with surgery services
  • If the service is related to the initial surgery, do not submit a separate claim (the surgery is included in the global payment)

 

Examples: Submitting Global Surgery Modifiers with Surgery Procedures

Return to O/R: A beneficiary had an appendectomy on May 15. The beneficiary has some significant lower abdominal pain 4 weeks after the surgery and now returns to the operating room for surgical removal of infected tissue by the original surgeon.

  • The return to the operating room was unplanned and was related to the initial surgery performed on May 15.
  • The original appendectomy procedure has a 90-day global period.
  • Submit CPT modifier 78 to signify that the second surgery is an exception to the global surgery package.

Unrelated Procedure in the Global Period: A beneficiary received a total knee replacement on June 6. 60 days later, the beneficiary fell at home and broke her arm, which required a surgical repair by the same physician.

  • The second surgery is unrelated to the initial surgery performed on June 6.
  • Submit CPT modifier 79 to signify that the second surgery, which was performed within the 90-day global period, is unrelated to the initial surgery.

Reference:

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