Global Period or Days denial for global surgery CPT

What is Global days/period and how to solve the denial?

Global Period denial a very easy and interesting scenario to learn. To make things easier There is an important and particular tool where you can check the coverage period. you will get the tool by end of this post.

Example: let us go with an example, Mary got an appointment for surgery with Dr.Patrick on 01/01/2018. There are three possible sessions. Before the surgery, during the surgery, after the surgery. these three phases are called Global period/days. This whole global surgical package also called Global surgery. It applies to all inpatient, outpatient, ambulatory surgical, doctor’s offices. Importantly, a valid modifier should be used. This is to show it is not a part of the global surgical package for reimbursement.

There are three main phases of global surgery

  • Zero-Day Postoperative Period.
  • 10-day Post-operative Period.
  • 90-day Post-operative Period.

Zero-Day Post-operative Period(000-code) Global Period

In this phase procedures like endoscopes and other minor treatments are included. Consequently, Evaluation and management procedures on Zero day post-operative period are nonreimbursable individually.

10-day Post-operative Period. (010-code)Global Period

same as the previous one comparatively higher than zero-day allowed and included in the fee payment. But, the evaluation and management code is not reimbursable.

90-day Post-operative Period. (090-Code)

One of the important phases is the 90-day postoperative period. Because major procedures are included in scheduled fee payment. same evaluation and management will not pay separately.

As already discussed above this is the tool where you can check the necessary information. This is a CMS tool where you can validate the post-operative periods. This applies to all the insurance that follow CMS guidelines.

http://www.cms.gov/apps/physician-fee-schedule/overview.aspx

Important format Notes to follow

Before Using the above link keep in mind to follow this step to identify the format. If you find this MMM/OOO/ZZZ/YYY instead of this format 000/010/090. This may be confusing follow the below format.

OOO – the global concept is not applicable.
MMM– Maternity CPT ( global days doesn’t apply)
ZZZ -inclusive code(service included to another service with a global period)
YYY – Contracted code for pricing where MAC determines the global day.

global procedural denial

Recommended action

To conclude, There can be two end actions you can get the service day and can check whether the day is within the global period. Meanwhile, If the service is within a Global period get the surgery CPT, diagnosis, and follow as per your protocol. Consequently, if the service not in a global period sends the claim back for reprocessing. However, some representatives would send the claim some may not depend on the payor.

CO119 denial code -Maximum benefit exhausted/services maxed out

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