Global Period

Abstract

Inherent to the understanding of surgical coding and reimbursement is the concept of the global period. This is also often referred to as “the global,” “global surgical period,” “surgical global,” or “global surgical package.” This nomenclature is interchangeable and will be used throughout the chapter to acclimate the reader to its synonymous uses. There are currently over 4000 CPT codes with a surgical global package in the Medicare payment schedule. The design of a global period centers around two key elements. First, there is a description of care steps rendered and the technical skill required to perform them. Second, there is an element of time. A surgical CPT code incorporates both of these elements when used to report a group of services or procedures that are customarily performed together. This is the essence of a bundled code. A CPT code is a bundled code by definition [1]. A single CPT code can, therefore, incorporate multiple procedures and/or steps that are used in conjunction within a given operation for a particular etiology – as designated by an ICD-10 code. These are the care steps that will be provided by the surgeon or surgical care team. The steps or components of care can loosely be divided into preoperative, intraoperative, and postoperative care fractions that when lumped together comprise the global period. In addition, certain services performed routinely in the immediate pre- and postoperative settings can be standardized based on time and complexity of decision-making to allow for a more reliable, resource-based reimbursement consideration for the global period. The time frame for any of these components of the CPT code can be variable. For example, each third-party payer can individually determine the number of days in which the follow-up care may take place. Taken as a whole, the global period includes all necessary services normally performed by a surgeon, before, during, and after a procedure. As mentioned, individual insurance payers may have different definitions of time and delivery of care elements. For purposes of this chapter, the guidelines set forth by Centers for Medicare and Medicaid Services (CMS) will be the basis for discussion. It is important to note that, while commercial payers may have subtle differences, the majority of concepts for payments and reimbursements are in step with the global surgical package as defined and maintained by CMS. It is also noteworthy that CPT is a product of the American Medical Association (AMA) and as such is on occasion contradictory to Medicare global payment policies – which are the product of CMS [1]. However, for the most part, the AMA and CMS were collaboratively. Most commercial payers will follow Medicare’s lead but can of course have their own caveats regarding global services and payments thereof. While there are many pros and cons to the global period as it relates to patient care and reimbursement, the history indicates that significant thought and work went into designing the framework of a global period that will make it difficult to quickly supplant.