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Medical coding plays a vital role in connecting healthcare providers with insurance companies, ensuring services are translated into codes for accurate billing. One concept that often confuses coders is the Global Period—a timeframe after surgery when routine follow-up care is already included in the original payment. Knowing these rules is essential, as mistakes can lead to either financial losses (underbilling) or compliance risks (overbilling).

What is the Global Period?

In simple terms, the global period refers to the number of days following a surgical procedure when standard post-op care cannot be billed separately. For instance:

• If a surgeon removes a gallbladder, the follow-up visits during the global period are bundled into the surgery fee.

• If the patient visits for an unrelated problem like a rash, that can be billed separately but only with the correct modifier.

Thus, the global period clearly defines billing boundaries and protects both coders and healthcare providers from errors.

Types of Global Periods

Not all surgeries have the same global period. Medicare categorizes them into three groups:

1. 0-Day Global Period – Covers only the day of surgery. Example: Minor diagnostic procedures.

2. 10-Day Global Period – Includes the surgery day and 10 days after. Example: Simple wound repairs.

3. 90-Day Global Period – Includes the day before surgery, the surgery day, and 90 days after. Example: Major surgeries like joint replacements or cardiac procedures.

Understanding which category applies is critical for correct billing.

Medicare Global Period Lookup

To identify the global period for a procedure, coders use the Medicare Physician Fee Schedule (PFS) Lookup Tool. Entering the CPT code reveals whether the surgery falls under 0-, 10-, or 90-day coverage. This is especially useful for coders in India working on US-based claims, as accurate use of the lookup tool ensures proper reimbursement and prevents claim denials.

Correct Use of Modifiers

Billing during a global period often requires modifiers to clarify whether a service is unrelated, staged, or unexpected. Key modifiers include:

• 24: Unrelated E/M service during the global period.

• 25: Significant, separately identifiable E/M service on the same day as a procedure.

• 58: Staged or planned procedure during the global period.

• 78: Unplanned return to the OR for a related issue.

• 79: Unrelated procedure performed during the global period.

For example, if a patient who had gallbladder surgery returns two weeks later with a throat infection, Modifier 24 is used since the visit is unrelated.

Common Mistakes Coders Make

Frequent errors include billing bundled post-op care, skipping the Medicare lookup tool, or applying the wrong modifier. Misjudging whether a condition is related to the original surgery also leads to denials. Staying updated and double-checking CPT codes is the best safeguard.

Practical Examples

• Cataract surgery (90 days): Skin infection visit on day 40 → bill with Modifier 24.

• Mole removal (10 days): Suture removal on day 5 → bundled, not separately billable.

• Knee replacement (90 days): Planned second surgery on day 70 → bill with Modifier 58.

Final Takeaway

The Global Period is a cornerstone of accurate medical billing. To avoid costly errors:

• Always know the global period for each CPT code.

• Use Medicare lookup tools instead of assumptions.

• Apply modifiers correctly.

• Avoid billing for routine bundled services.