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Global Period Services

  1. If a surgery/procedure is cancelled pre- or postinduction, can the surgeon bill an E/M based on the preoperative history, examination and plan that is documented, detailing why the surgery was cancelled?

    Answer:
    When a surgical procedure is cancelled, either pre- or postinduction, the surgeon’s preoperative E/M service is no longer bundled into the surgical package and may be separately billed. Of course, if the surgery were to be performed later that same day, the E/M would again be bundled into the package. Updated 6/9/2017
     
  2. What constitutes “start of procedure” per CMS?

    Answer:
    CMS considers surgical incision (or start of procedure if no incision required) as the start time for the procedure. Updated 6/9/2017
     
  3. What scenario/situation is appropriate for use of modifiers 24 and 25 on the same claim for an E/M service, e.g., 99212 24/25?

    Answer:
    Modifier 24 describes an E/M service during a global period, unrelated to the procedure that established the global period, while modifier 25 describes a separately identifiable E/M service when a procedure is performed during the same encounter. The need for both of these modifiers on the same claim during a global period would be unusual; the following scenario is an example of a scenario in which both modifiers could be used:
    • A patient is seen by the operating surgeon for an office f/u mid-level visit, two weeks after a hemi-colectomy. During the visit, the patient presents with an infected abscess on the right shoulder. The provider addresses this unrelated problem and recommends a course of antibiotics. This service could appropriately be billed as 99213 24, since it is unrelated to the hemi-colectomy. 
    • If the provider scheduled the patient for a f/u visit for possible I&D of the abscess,  and the patient presented with two additional abscesses that required further evaluation, billing for the second visit could include 99213 24/25, along with, along with CPT 23030 for the I&D. Updated 6/9/2017

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