General Surgery Billing

Global Surgical Packages consist of all procedures and services performed by the healthcare provider prior to, during, and after the procedure. Medicare reimbursements include payments for all applicable services, including pre-operative, intra-operative, and post-operative services. Complications that arose during the procedure are also covered by Medicare.

The services included in Global Surgical Packages can be furnished into any setting, such as ambulatory surgical centers, hospitals, and clinics. Follow-ups and visits by a physician, to a patient in critical care or intensive care, are also included. The payments made for visits in intensive care may be paid separately if the patient requires long-term management, such as seriously injured, burned, and requires constant supervision or attendance by the physician.

General surgery codes are categorized under two classifications – major surgery and minor surgery. The difference in the type of surgery reflects in the Current Procedural Terminology (CPT) codes and the Healthcare Common Procedure Coding System (HCPCS) guidelines. These categories greatly affect the amount paid out to the providers. It’s imperative that the billing personnel accurately specify the surgery that the patient is having.

Surgeries are considered major surgeries if the procedure requires 90 post-operative days. According to the Global Surgical Package, the period for major surgeries starts immediately from the day following the surgery, and the 90 days following the procedure.

Minor surgeries are procedures that require 0 to 10 days post-operative care. The global period for post-operative care is the day following the surgery up to 10 days after the surgery. The Current Procedural Terminology categorizes several diagnostic procedures under minor surgeries, and therefore, usually requires no post-operative care. However, these minor surgeries, that are strictly diagnostic in nature, are also entitled to a pre-procedural allowance.

The Global Surgical Package lists the procedures that are usually included in a general surgical procedure. The following procedures are listed as included in a general surgery and paid out to the provider who performed the surgery.

1. Intraoperative services – These are the procedures usually included and necessary in a surgical procedure
2. Pre-operative visits – Surgeries that require pre-operative visits after the recommendation to operate beginning with the day prior to the surgery for major surgeries, and the actual day of the surgery for minor surgeries
3. Complications following the surgery – When complications arise during the surgery that requires additional medical or surgical services required of the general surgeon during the post-operative care period that do not require additional usage of the operating room
4. Post-surgical pain management -The pain management medication during post-operative care
5. Post-operative physician visits – Physician visits during the post-operative procedure related to the recovery of the patient
6. Required services and supplies – The required care during the post-operative period, including dressing changes, removal of cutaneous sutures, staples, wires, drains, casts, insertion, removal of urinary catheters, routine servicing of the peripheral intravenous lines, splints, nasogastric tubes, rectal tubes, tracheostomy tubes, removal of operative pack, local incision care.

Surgeons, who perform the surgical procedure and provide all of the pre-operative and post-operative services, bill the insurer or the payer for the global package by entering the appropriate CPT code for the surgical procedure alone.

Billing is prohibited for the other visits included in the global service package. The physician who performs the procedure is shown in the billing documents as the performing physician.