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 a single CPT (Current Procedural Terminology) code includes for a specific surgery or procedure. The concept simplifies the billing process. It groups together all necessary services related to a surgical procedure. As a result, the coder reports only one code 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. However, the global surgical package typically includes common components:

1. Preoperative Services:

   • This includes all the services and assessments necessary before the surgeon performs the surgery. These may involve:
     • Preoperative visits: For major surgery, the package includes the surgeon’s visits on the day before and the day of surgery. However, the visit where the surgeon decides to operate is separate; report it with modifier 57. For minor procedures, the package covers the procedure day only.
     • Preoperative diagnostic testing: Not included. Lab work, imaging, and other tests that evaluate the patient before the procedure are reported separately.
     • 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: Local or topical anesthesia that the surgeon provides is included. However, anesthesia by an anesthesiologist or nurse anesthetist is not part of the surgeon’s package, so the anesthesia provider bills it separately.
     • 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. The global surgery package typically covers these services. This applies as long as they relate directly 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: Complications may arise within the global period, such as infection, bleeding, or other issues directly related to the surgery. The global surgical package covers these, as long as they do not require a return to the operating room. A related return to the operating room is reported separately with modifier 78.
     • 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 global package typically includes the care of surgical dressings, if needed.
   • Pain management: The package includes postoperative pain management by the surgeon. However, a different provider, such as an anesthesiologist who places a nerve block for postoperative pain at the surgeon’s request, may bill that service separately.

Global Surgical Periods

A critical aspect of understanding the surgical package is the “global period.” The global period refers to the timeframe during which the surgical package includes postoperative care. This period can vary depending on the type of surgery. Coders recognize three main types:

1. 0-Day Global Period:

   • The package includes services on the day of the procedure only. There is no preoperative day before and no postoperative period after that day.
   • This is common for endoscopies and some minor procedures. As a result, visits on later days are reported separately.

2. 10-Day Global Period:

   • This applies to minor procedures. The package covers the day of the procedure plus the 10 days that follow. There is no preoperative day before.
   • Follow-up care typically includes office visits to monitor recovery. It also includes additional services like suture removal or addressing minor complications within this period.

3. 90-Day Global Period:

   • This applies to major surgeries.
   • The package covers the day before surgery, the day of surgery, and the 90 days after it. This includes follow-up visits and complications that do not require a return to the operating room. However, physical therapy is not part of the package, so the therapist bills it separately.

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 visits, the surgery itself, and postoperative visits), the coder bundles everything 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. Coders use modifiers for these situations. For example, modifier 24 identifies an unrelated evaluation and management service during the postoperative period. Modifier 22 (increased procedural services) works differently, because it reports work that is substantially greater than typical for the procedure itself. Documentation must support it.
• Exclusions from the Surgical Package:
  • The surgical package does not include some services, such as:
    • Diagnostic tests, including preoperative labs and imaging.
    • Complications that require a return to the operating room, plus care for problems unrelated to the surgery.
    • 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. Therefore, if a provider performs a service outside the scope of the surgical package, 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 visits, the surgical procedure itself, intraoperative care, postoperative services, and complications within the global period that do not require a return to the operating room. Medical coders and providers should understand what the surgical package does and doesn’t include. As a result, they can ensure accurate billing and proper reimbursement while also complying with insurance guidelines and policies.

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