The Global Surgical Package
The global surgical package includes all routine services typically provided by the physician (or by members of the same group practice and specialty) before, during, and after a procedure. Physicians within the same group and specialty must bill and receive payment as if they were a single provider.
For most surgical procedures, Medicare payment covers both the procedure itself and the related post-operative care provided during the designated global period, which is usually 10 or 90 days following the surgery (global period).
Components of the Global Surgery Package:
Pre-Operative visits after the decision to operate.
For Major Procedures: preoperative visits the day before surgery is included.
For Minor Procedures: pre-operative visits on the surgery day are included.
Intra-Operative services, normally an integral part of a surgical procedure.
This includes supplies (except exclusions) and services like:
Dressing changes (intra or post op)
Local incision care
Insertion, irrigation, and removal of urinary catheters, routine peripheral intravenous lines, nasogastric and rectal tubes
Post-Operative services and visits, including:
Medical or surgical services the surgeon provides during the post-op period because the complications don’t require more trips to the operating room (OR).
Follow-up post-op recovery period visits
Post-surgical patient pain management
Removal or operative packs
Removal of cutaneous sutures and staples, lines, wires, tubes, drains, casts, and splints
The Global Period
The global period is a standardized timeframe (0, 10, or 90 days) following a surgical procedure that bundles pre-operative, intra-operative, and post-operative care into a single fee paid to the surgeon.
Knowing what is bundled into the global package prevents claim denials and eliminate coding errors.
0-Day Global Period
The 0-Day period covers only the procedure itself. There is no pre-op or post-op period.
It applies to endoscopies and some minor procedures.
Common examples include:
Acne Surgery (CPT 10040)
Certain Debridement Procedures (e.g., 11042)
Certain Injections/Aspirations (e.g., 20610)
Endoscopies (e.g., 31255)
10-Day Global Period
The 10-Day period covers the procedure plus routine post-operative care for 10 days. This actually makes the global period 11 days total.
Routine follow-up, such as suture removal or wound check should not be billed separately. Common examples include:
Benign lesion excision(s) (e.g., 11401)
Destruction of malignant skin lesions
Small laceration repairs
Simple wound repairs (e.g., 12002)
90-Day Global Period
The 90-Day period covers one day of pre-operative care, the procedure, plus routine post-operative care for 90 days. This actually makes the global period 92 days total.
All routine follow-up visits, wound care and suture removal, pain management and minor complication treatment is included. Common examples include:
Hip replacement procedures
Major cardiovascular surgeries
Total knee replacement (e.g., 27447)
