Medical Coding A Surgical Package

What Is Included in a Surgical Package? A Guide to Medical Coding

In the world of medical coding, understanding the components of a “surgical package” is essential for accurate billing and reimbursement. A surgical package, also known as a “global surgical package,” refers to the bundle of services that are included under a single CPT (Current Procedural Terminology) code for a specific surgery or procedure. The concept simplifies the billing process, as it groups together all necessary services related to a surgical procedure and ensures that only one code is used for the entire surgical event.

Components of a Surgical Package

The services that fall under a surgical package can vary based on the type of surgery and the payer’s policies, but there are common components typically included in the global surgical package:

1. Preoperative Services:

   • This includes all the services and assessments necessary before the surgery is performed. These may involve:
     • Pre-surgical consultations: If the patient requires a medical evaluation or specialist consultation to assess their readiness for surgery.
     • Preoperative diagnostic testing: Lab work, imaging, or other tests necessary to evaluate the patient’s condition before the procedure.
     • Preoperative preparation: Any procedures done to prepare the patient for surgery, such as marking the surgical site.

2. Surgical Procedure:

   • The actual surgery is the core of the surgical package and includes the operation performed by the surgeon. It encompasses:
     • Surgical planning and execution: This covers the procedures performed by the surgeon, including incision, dissection, and closure.
     • Anesthesia administration: The services provided by an anesthesiologist or nurse anesthetist, including monitoring during surgery. However, anesthesia is often billed separately from the surgical package.
     • Use of surgical tools and equipment: The surgical instruments, sutures, and devices used during the operation.

3. Intraoperative Services:

   • Any services that are provided during the surgical procedure itself, such as monitoring and management of the patient’s vital signs or handling any complications that arise during surgery. These services are typically covered under the global surgery package, as long as they are directly related to the surgical procedure.

4. Postoperative Services:

   • After the surgery, the surgeon is responsible for the care of the patient, which may include:
     • Follow-up visits: Postoperative appointments to monitor the patient’s recovery and address any issues like wound healing, infections, or complications.
     • Management of complications: If complications arise within the global period, such as infection, bleeding, or other issues directly related to the surgery, these are generally covered as part of the global surgical package.
     • Routine postoperative care: This includes dressings, removal of sutures or staples, and other routine services needed as part of recovery.

5. Related Services:

   • Surgical dressings: The care of surgical dressings, if needed, is typically included in the global package.
   • Pain management: In certain cases, management of post-surgical pain, such as medications and other treatments, may be included in the package, though this can depend on the specific surgical procedure and payer policies.

Global Surgical Periods

A critical aspect of understanding the surgical package is the “global period.” The global period refers to the timeframe during which postoperative care is included as part of the surgical package. This period can vary depending on the type of surgery and is categorized into three main types:

1. 0-Day Global Period

   :

   • No follow-up care is included after the surgery, and the patient does not require postoperative care.
   • This is common for minor procedures where the patient can be sent home immediately after the surgery, without the need for follow-up visits.

2. 10-Day Global Period:

   • The patient receives postoperative care for up to 10 days following the surgery.
   • Follow-up care typically includes office visits to monitor recovery, and additional services like suture removal or addressing minor complications within this period.

3. 90-Day Global Period:

   • The most common global period, especially for major surgeries.
   • The surgeon’s care is covered for 90 days postoperatively, which includes follow-up visits, managing complications, and other related services like physical therapy if prescribed.

Key Points About the Surgical Package

• Bundling of Services: One of the primary benefits of the surgical package is that it simplifies the billing process. Instead of billing each individual service separately (such as preoperative consultations, the surgery itself, and postoperative visits), everything is bundled into one code.
• Modifiers and Exceptions: In certain circumstances, additional services or procedures performed outside of the normal surgical package may be eligible for separate billing. Modifiers, such as modifier 22 (increased procedural services) or modifier 24 (unrelated evaluation and management services), are used to indicate that services should be reimbursed separately.
• Exclusions from the Surgical Package:
  • Some services are not included in the surgical package, such as:
    • Diagnostic tests not related to the surgery.
    • Follow-up care for complications not related to the surgical procedure.
    • Non-surgical treatments like physical therapy or additional treatments that are unrelated to the surgery.
• Reimbursement Implications: Understanding the surgical package is crucial for both healthcare providers and insurance companies. If a service is provided that is outside the scope of the surgical package, it is important to use appropriate modifiers and codes to ensure accurate reimbursement.

The surgical package is an essential concept in medical coding and billing, encompassing a comprehensive bundle of services associated with a surgical procedure. This includes preoperative evaluations, the surgical procedure itself, intraoperative care, postoperative services, and management of complications within the global period. By understanding what is and isn’t included in the surgical package, medical coders and providers can ensure accurate billing and proper reimbursement while also complying with insurance guidelines and policies.