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POLICYThe global surgical package concept in CPT includes the pre-operative, intra-operative, and post-operative surgical services. Starred and "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.
Important Note: The definition of "global surgical package changed on January 1, 2002.
You can find the new definition in the Surgery Guidelines found at the beginning of the Surgery Section in the CPT manual.
Additional services performed due to complications, exacerbations, recurrence, or the presence of other diseases or injuries should be reported separately.
"Add-on" procedures are subsidiary or adjunct procedures. These procedures are never performed alone. They are carried out as an added component of a primary procedure. Most "add-on" procedures can be identified by the phrase "each additional" or "list separately in addition to" in the description of the codes. A comprehensive list of "add-on" procedures can be found in Appendix D in the back of the CPT Manual.
Since "add-on" codes are adjunct codes, modifier -51 should never be appended to these codes. The allowable charge for these procedures should not be reduced to 50%.
"Exempt from Modifier -51" Procedures
Modifier -51 is not applicable to the "Exempt from Modifier -51" procedures. A comprehensive list of these procedures is found in Appendix E in the back of the CPT manual. The allowable charge for these procedures is not reduced to 50%.
Starred procedures are minor surgical procedures that include the surgical procedure only (i.e., intra-operative services). CPT identifies starred procedures with the (*) symbol, which follows the procedure code in the CPT manual.
The global surgical concept is not applicable to starred procedures. The associated 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 as the starred procedure.
There are specific rules governing starred procedures that are listed in the Surgery Guidelines at the beginning of the Surgery section in the CPT manual.
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
The 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 ProceduresTop