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POLICYThe global surgical package concept in CPT includes the pre-operative, intra-operative, and post-operative surgical services. Add-on" procedures are exempted from the global surgical package concept.
Certain pre-operative services, the performance of the surgical procedure (including procedures that are an integral component of a procedure), and all uncomplicated follow-up care are included in the CPT surgical package.
Please note that additional services performed due to complications, exacerbations, recurrence, or the presence of other diseases or injuries should be reported separately.
When a physician performs more than one procedure/service on the same date, same session or during a post-operative period (subject to the "surgical package" concept), several CPT modifiers may apply. Appendix A of the CPT should be used to select the one most appropriate.
Separately, identifiable E/M services associated with pre-operative and post-operative services can be reported separately on a service-by-service basis.
Modifier -25 should be appended to E/M services performed on the same day to indicate that the patient's condition required a significant, separately identifiable E/M service above and beyond the other service provided or beyond the usual preoperative and postoperative care associated with the procedure that was performed.
The global surgery policy does not apply to services of other physicians who may be rendering services during the preoperative or postoperative period, unless the physician is a member of the same group and/or specialty as the operating physician.
Primary Surgical Procedure Determination
BCBSMS uses the relative value units (RVU) from the Resource Based Relative Value Scale (RBRVS) to determine which multiple surgical procedure is the primary surgical procedure. The procedure with the highest relative value units is selected as the primary surgical procedure (excludes "add-on" and "exempt from modifier -51" procedures). We use the 'Fully Implemented Non-Facility Total" relative value units to make the determination.
RBRVS is also used to determine post-operative global surgical days. The global surgical days are found in the column entitled "Glob Days". Post-operative global days can range from 0 to 90 days. Pre-operative global surgical days are determined by CPT guidelines. The guidelines are found in the Surgery Guidelines, which are located at the beginning of the Surgery section in the CPT manual. Currently, pre-operative days include the day prior to surgery and the day of surgery, excluding the visit in which the decision to perform surgery was decided.
You can access RBRVS by clicking this link - http://www.cms.hhs.gov/providers/pufdownload/rvudown.asp
POLICY GUIDEINESThe coding guidelines outlined in Coding Policy should not be used in lieu of the Member's specific benefits plan language.
POLICY HISTORY1/2003: Policy developed
6/2003: Policy revised
5/20/2004: Added section for Primary Surgical Procedure Determination and Exempt from Modifier -51 Procedures
3/20/2006: Policy revisedTop