If you’re responsible for coding, billing, or managing revenue in a medical practice, understanding global surgical periods isn’t optional—it directly impacts your bottom line. Misunderstanding what’s included (and what’s not) leads to underbilling, denied claims, and lost revenue.

The reality? Most practices leave money on the table simply because documentation and modifier usage don’t align with payer expectations. Learn exactly how global periods work—and what you should do differently starting today to protect your reimbursement. If your team treats global periods as a “set it and forget it” rule, you’re likely missing key exceptions that could be billed. The difference between average and high-performing practices often comes down to how well they understand and apply these rules in real scenarios.

Understanding the Global Surgical Package (Bundled Payments Made Simple)

What the Global Period Actually Means for Your Practice

The global surgical package is a bundled payment model where you receive one payment for all services tied to a procedure. That includes pre-op, intra-op, and post-op care within a defined timeframe.

According to the Centers for Medicare & Medicaid Services (CMS), this structure is designed to simplify billing and prevent duplicate charges. But for your practice, it means you must clearly distinguish between included services and separately billable ones.

Why Payers Use Bundled Payments (And What That Means for You)

Insurance companies use bundled payments to control costs and prevent unbundling—billing each component separately to increase reimbursement.

That means:

• Routine care = INCLUDED
• Exceptions = ONLY paid if documented and coded correctly

Your job is to identify the exceptions and prove they qualify. This requires coordination between providers, coders, and billing staff. Without that alignment, even legitimate claims can be denied.

Why CMS Rules Should Guide Your Coding Strategy

Even if you bill commercial payers, most align with CMS rules. That’s why CMS guidance is your baseline for compliance and reimbursement accuracy.

If your team isn’t trained on CMS global surgery rules, you’re likely:

• Missing legitimate revenue opportunities
• Misusing modifiers
• Increasing audit risk

You should also be auditing your claims periodically against CMS guidance to catch issues early and improve performance.

Global Surgical Periods: 0, 10, and 90 Days (What You Need to Know)

0-Day and 10-Day Global Periods (Minor Procedures)

Minor procedures usually fall into:

• 0-day global → No post-op period
• 10-day global → Short recovery window

Any follow-up care related to the procedure during that time is included in the original payment.

However, not every visit during that timeframe is automatically bundled—this is where practices make mistakes. You must evaluate whether the service is routine or medically distinct.

90-Day Global Period (Major Surgeries)

Major procedures include:

• 1 day pre-op
• Day of surgery
• 90 days post-op care

According to CMS, pre-operative visits the day before surgery (for major procedures) are included in the global package. This longer window creates more risk for missed billing opportunities, especially when patients return with unrelated issues.

How to Verify Global Days (Don’t Guess)

Never assume a global period. Always verify using:

• CPT® code book (from the American Medical Association)
• HCPCS Level II
• CMS Physician Fee Schedule

Even experienced coders make mistakes when they rely on memory instead of verification.

What’s Included in the Global Surgical Package

Pre-Operative Care (Usually Included)

Pre-op visits the day before (major procedures) or day of surgery (minor procedures) are bundled and not separately billable.

However, the visit that leads to the decision for surgery is separately billable, which is a critical distinction many practices miss.

Intra-Operative Services

This includes:

• The surgery itself
• Surgical team services
• Local/regional anesthesia

These are always part of the bundled payment and cannot be billed separately under CMS rules.

Post-Operative Care (Where Most Mistakes Happen)

Included services:

• Routine follow-ups
• Suture removal
• Standard pain management

If the care is related to recovery, it is bundled. The challenge is identifying when care is not routine.

Complications and Supplies

Minor complications treated without returning to the operating room are typically included. Routine supplies are also bundled.

Always review payer-specific policies for exceptions.

What You CAN Bill Separately (Big Revenue Opportunities)

Decision for Surgery Visits

If an evaluation leads to surgery, it is separately billable. Use modifier -57 for major procedures.

Diagnostic Services

Tests performed to determine the need for surgery are NOT part of the bundle. These services help establish medical necessity and should be billed accordingly.

Unrelated E/M Visits

If a patient presents with a completely different issue, you can bill it. Documentation must clearly support that the condition is unrelated.

Return to the Operating Room

These are separately billable depending on the scenario:

• -58 → Planned
• -78 → Complication
• -79 → Unrelated

Incorrect use of these modifiers is a major audit risk.

Modifiers: Your Key to Getting Paid Correctly

Modifier -24 (Unrelated Visit)

Used for unrelated E/M services during the global period. Clear documentation is required to avoid denials.

Modifier -25 (Same-Day E/M + Procedure)

Used when a significant, separately identifiable E/M service is performed. This is one of the most audited modifiers in healthcare.

Modifier -57 (Decision for Surgery)

Used ONLY for major procedures. Ensures proper reimbursement for the visit that led to surgery.

Modifiers -58, -78, -79 (Return to OR)

These determine whether additional procedures are payable. Training and consistency are essential to avoid errors.

Documentation: The #1 Factor in Getting Paid

Why Your Documentation Matters More Than Coding

You can’t code what isn’t documented. If your documentation doesn’t clearly support the service, your claim will not hold up.

Use ICD-10 Codes to Prove Your Case

Accurate diagnosis coding supports:

• Modifier use
• Claim approval
• Audit protection

Your diagnosis must clearly support medical necessity.

Turn Knowledge Into Revenue

Understanding global surgical periods is more than compliance—it’s revenue protection.

When you:

• Know what’s included
• Identify what’s excluded
• Use modifiers correctly
• Document thoroughly

You stop leaving money on the table. Ongoing education and consistent auditing will keep your team compliant and profitable.

Stay Ahead of Coding Changes and Compliance Risks Accurate coding and billing require more than understanding a single rule or modifier—they require ongoing education and a commitment to continuous improvement. As regulations, payer policies, and reimbursement requirements change, your team’s knowledge must evolve as well. With an All-Access Pass subscription, you’ll gain year-round access to expert-led healthcare training designed specifically for medical practices. From coding and compliance to reimbursement and practice management, you’ll have the resources needed to keep your staff informed, productive, and prepared for whatever changes come next.

 

---