Key takeaways
- Major surgery has a 90-day global period that starts the day before surgery.
- Minor procedures have a 0 or 10-day global period.
- Routine post-op care is included and reported with 99024.
- Modifiers 24, 25, 57, 58, 78 and 79 identify separately billable work inside a global.
What a global surgical package is
Under Medicare's global surgery rules, one payment covers the procedure and the related care around it for a set number of days. Most commercial payers follow the same approach. Billing a visit that is already included leads to denials; missing a visit that is billable leaves money on the table.
The three global periods
| Global period | Applies to | Window |
|---|---|---|
| 0-day | Endoscopies and some minor procedures | The day of the procedure |
| 10-day | Minor procedures | The day of the procedure and the 10 days after |
| 90-day | Major surgery | The day before, the day of, and the 90 days after |
What is included
- Pre-operative visits after the decision for surgery (the day before or day of, for major surgery)
- The surgery itself and related intra-operative services
- Routine post-operative visits, dressing changes and suture removal
- Post-operative pain management by the surgeon
- Treatment of complications that do not require a return to the operating room
Routine post-op visits are reported with 99024 for tracking, at no charge.
The modifiers that make work billable
| Modifier | Use it when |
|---|---|
| 24 | An unrelated E/M visit during the post-op period |
| 25 | A significant, separately identifiable E/M on the same day as a minor procedure |
| 57 | The E/M visit where the decision for major surgery was made, the day before or day of surgery |
| 58 | A staged, planned or more extensive related procedure during the post-op period; a new global starts |
| 78 | An unplanned return to the operating room for a related complication; no new global starts |
| 79 | An unrelated procedure during the post-op period; it starts its own global |
Split care: modifiers 54, 55 and 56
When different physicians share the package, the surgeon bills the surgical care only with 54, the physician providing post-op care bills with 55, and pre-operative care only is billed with 56. Each gets the share of the payment for their part.
Common mistakes
- Billing a routine post-op visit as a regular E/M
- Using 25 instead of 57 for the decision visit before major surgery
- Missing 24 on a truly unrelated visit, with a diagnosis that does not show it is unrelated
- Using 78 when the return to the OR was planned (that is 58)
- Counting the 90 days from the wrong date
Try the global period checker on our orthopedic billing page to test a scenario.
Frequently asked questions
When does a 90-day global period start?
The day before the surgery. The window covers the day before, the day of surgery and the 90 days after.
What is the difference between modifier 58 and 78?
Modifier 58 is for a staged, planned or more extensive related procedure and starts a new global period. Modifier 78 is for an unplanned return to the operating room for a complication and does not start a new global period.
Can I bill an E/M during a global period?
Only if it is unrelated to the surgery (modifier 24), is the decision for major surgery (modifier 57), or is a significant, separately identifiable service on the day of a minor procedure (modifier 25).