A Billing Guide To The Global Surgery Modifiers

Understanding the global surgery modifiers that are performed is important since it will help you get an idea about all the services that get normally furnished by the surgeon during, before or even after the procedure is complete. The medicare payment for the surgical procedures is inclusive of the intra-operative, post-operative and pre-operative services that are performed in a routine manner by the medical professionals.

There are certain guidelines that must be followed when it comes to surgical modifiers since these modifiers are widely used by medical professionals in their field in order to demonstrate a medical billed service that is not a part of the global surgery modifiers and is hence entitled to a separate process of reimbursement.

Make Use of The Following Guidelines When Using Global Surgery Modifiers

Global Surgery Modifier How Do I Use Modifiers And How To Get The Most Reimbursement During A Global Period?

These are the important medical coding modifiers that you need to be aware of. 

Modifier ‘24’

Unrelated evaluation and management coding service by a similar medical professional during the postoperative time period. The surgeon might have to demonstrate that an evaluation and management coding service (E/M) was appointed during the period that followed post-operation due to an unrelated procedure. Due to the E/M service being billed with the modifier ‘24’ it is crucial to accompany the relevant documents that support the medical service and are not connected with the care during the post-operative care. In order for the E/M services to be payable in nature during the post-operative time with the specific modifier ‘24’, it is crucial that the medical diagnosis code that supports the evaluation and management coding service is not similar to the medical diagnosis code that was reported for the surgery performed earlier. 

Modifier ‘25’

Notable yet individually identifiable E/M services by the same medical professional on the day of the medical procedure or during any of the other services. The original medical evaluation that takes place for the smaller surgical procedures along with the endoscopies gets included in the package of the global surgery. The visits by similar medical professionals on the very same day as the minor endoscopy or surgery get included in the package until and unless a noteworthy or a separately identifiable service gets performed. 

Modifier ‘25’ is therefore used during the billing process of the different E/M services by the same kind of physician on the same day when medical procedures take place.

Modifier ‘57’

An E/M service that results from the initial decision of performing the surgical procedure will be identified with the addition of the CPT modifier 57 to the relevant level of the evaluation and management service. The evaluation and the management services on the day before or during the day when the major surgery that took place do not get included in the payment of global surgery. 

This E/M code modifier must not be used during the physician’s visit during the global period during which minor surgical procedures take place, until and unless the visit’s purpose is to decide whether or not a major surgery should take place. This particular modifier is not used in regard to minor surgeries since the global period for the minor surgeries does not include the day before the surgery. When the decision is therefore taken in order to perform the smaller procedures it is typically done before the medical service takes place. It is therefore considered a procedural preoperative service and a consultation or a visit do not get added to the final medical bill of the procedure. 

Modifier ‘58’

A related or a staged service or procedure by the same medical professional during the postoperative period was created in order to make things easier for the process of medical billing of related or staged surgical procedures that occur during the period of post-operation of the first procedure. CPT modifier ‘58’ may also be reported with the procedure of the CPT. A new postoperative period begins with the next procedure when the series gets billed. This modifier is indicative of the performance of the service or procedure during the postoperative period. 

  • It is more extensive than the first procedure
  • Panned in a prospective manner or during the time of the original medical procedure
  • For the purpose of therapy that is followed after the diagnostic surgical procedure

Modifier ‘59’

This refers to the distinctive procedural service. Under certain situations, it might be necessary to demonstrate a service or a procedure that was independent or distinct from the other evaluation and management coding services that are performed in a single day. 

Modifier 59 is therefore used in order to identify services or procedures other than the evaluation and management services that are not reported in conjunction with one another but are relevant under the circumstances. It is important to remember that the process of documentation must support a different kind of session, different organ system or site, different surgery or procedure, separate injury, separate lesion or separate excision or incision. However, when another modifier is appropriate and has already been established that one must be used over modifier 59. 

Modifier ‘78’

With the addition of the CPT code, medical professionals tend to report modifier ‘78’ as the unplanned return to the procedure or the operating room by a similar medical professional that follows the initial procedure during the postoperative period. The surgeon may also say that another procedure was executed during the postoperative period.

Modifier ‘79’

Unrelated service or procedure by the same surgeon during the postoperative period. The surgeon may have to indicate that a service or procedure appointed during the postoperative period was unrelated to the procedure that took place originally. A new postoperative period, therefore, begins when the unrelated medical procedure gets billed. 

Therefore, to understand global surgery modifiers this article will come in handy. It has all of the modifiers that can be accurately used for medical coding and billing.  In case you are looking to hire a service provider to handle your healthcare company’s medical billing, Synergy HCLS is one the best options to consider.