Global Period

  • Ketan R. ShethEmail author


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.


American Medical Association Payment Scheme Global Package Critical Care Service Care Step 
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  1. 1.
    Vines Allen D, Braceland A, Rollins E, Miller S. Comprehensive health insurance: billing, coding, reimbursement. 2nd ed. Upper Saddle River: Pearson; 2013.Google Scholar
  2. 2.
    Dunn D, Hsiao WC, Ketcham TR, et al. A method for estimating the preservice and postservice work of physician’s services. JAMA. 1988;260(116):2371–8.CrossRefPubMedGoogle Scholar
  3. 3.
    Hsiao WC, Braun P, Becker ER, et al. A national study of resource-based relative value scales for physician services: final report to the HCFA, publication 18-C98795/1-03. Boston: Harvard School of Public Health; 1988.Google Scholar
  4. 4.
    Hsiao WC, et al. A national study of resource –based relative value scales for physician services. Harvard University Phase II Study. Final report 1:490. 30 Sept 1990 (revised).Google Scholar
  5. 5.
    Hsiao WC, et al. A national study of resource –based relative value scales for physician services. Harvard University Phase III Study. Final report 1:37. 30 Aug 1992 (revised).Google Scholar
  6. 6.
    Department of Health and Human Services-Centers for Medicare and Medicaid Services: Medicare Learning Network. March 2015 ICN907166.
  7. 7.
    Reed RL, Luchette FA, Esposito TJ, et al. Medicare’s global terrorism: where is the pay for performance? J Trauma. 2008;64:374–84.CrossRefPubMedGoogle Scholar
  8. 8.
    Mabry C. The global surgical package-let’s get the facts straight. J Trauma. 2008;64:385–7.CrossRefPubMedGoogle Scholar
  9. 9.
    Medicare Claims Processing Manual. Chapter 12, Section 40.1. Accessed 10 Oct 2015.
  10. 10.
    American Medical Association. 2015. Accessed 20 Oct 2015.
  11. 11.
  12. 12.
    American Academy of Orthopedic Surgeons. Accessed 12 Sept 2015.
  13. 13.
    Mabry CD. Trauma services: coding for optimal practice management. Bulletin of the American College of Surgeons. 2003;88(10):13–24.Google Scholar
  14. 14.
    Burwell SM. Setting value-based payment goals-HHS efforts to improve US health care. N Engl J Med. 2015;372(10):897–9.CrossRefPubMedGoogle Scholar
  15. 15.
    Tsai TC, Miller DC. Bundling payments for episodes of surgical care. JAMA Surg. 2015;150(9):905–6.CrossRefPubMedGoogle Scholar
  16. 16.
    The Lewin Group. CMS bundled payment for care improvement inititiative models 204: year 1 evaluation and monitoring annual report. 2015.Google Scholar
  17. 17.
    Miller DC, Gust C, Dimick JB, et al. Large variations in Medicare payments for surgery highlight potential from bundled payment programs. Health Aff. 2011;30(11):2107–15.CrossRefGoogle Scholar

Copyright information

© Springer International Publishing Switzerland 2017

Authors and Affiliations

  1. 1.Alternate Advisor to the AMA RUC, Division of General SurgeryCambridge Health Alliance, Harvard Medical SchoolCambridgeUSA

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