This coding expert answers common coding questions to help you run a more efficient practice.

By Inga Ellzey, M.P.A., R.H.I.A., C.D.C.
Recently, I’ve received several questions related to surgical topics. A popular question I’m asked is “What do I need to know about the global surgical package?” This month, I’ll address that question plus more, including information about how to determine when the post-operative period begins. Q: What exactly is meant by the concept of the “global surgical package”? Is there one guideline that all carriers must follow? Any details about this would greatly help. A: The global surgical package differs in definition by each carrier. Medicare has designed and implemented guidelines for this concept that are widely accepted by the majority of insurers in the United States. To be clear, I’ll define the guidelines published by Medicare with the caveat that some local carriers may adhere to only portions of the Medicare policy while others publish unique rules. You and your staff need to verify the global surgical package guidelines with each of your contracted carriers. Here’s a summary of the Medicare rules and guidelines that govern the concept of the global surgical package. An Overview The global surgical package includes all necessary services normally furnished by the dermatologic surgeon before, during and after the surgical procedure. Most dermatologic surgery CPT codes start with a “1” (for example, 11100, 11642, 17000). Medicare has divided surgical services into three categories: surgeries with 0, 10 and 90 post-operative days. Services that are considered part of the global surgical fee include: 1. Pre-operative visits after the decision is made to operate beginning with the day before major surgical service and the day of minor surgeries. 2. Visits during the post-operative period of the surgery that are related to the recovery from the surgery. These services include: a. post-operative pain management b. dressing changes c. local incision care d. removal of operative packs e. removal of cutaneous sutures, staples or drains. 3. All additional medical or surgical services required by the surgeon during the post-operative period because of complications that don’t require additional trips to the “operating room.” Services not included in the global surgical fee are: 1. the initial consultation or evaluation of the problem by the physician/ surgeon to determine the need for the surgery 2. visits unrelated to the diagnosis for which the surgical procedure is performed, unless the visits occur from surgical complications 3. treatment for the underlying condition or an added course of treatment that’s not part of the normal recovery from surgery 4. diagnostic tests and procedures 5. treatment for post-operative complications that requires a return trip to the “operating room” 6. the performance of a more extensive procedure if the less extensive procedure fails 7. surgical trays furnished in the physician’s offices. Only four CPT codes in the integumentary section cover surgical trays. They are 19110, 19120, 19125 and 19126. Q: When does the post-operative period begin, and how do I know how many days are included in the global surgical package for each CPT code? A: The post-operative period begins at 12:01 a.m. of the next day following when the surgical service was rendered. Each surgical service has post-op days assigned to it. Medicare divides all surgical services into two major categories: major and minor procedures. Major procedures are those with 90 post-operative days. Minor surgical services are those with 0 or 10 days in the global surgical package. • 0-day services. These commonly include CPT codes 11100/11101, 17304-17310, 11300-11313, 11900/11901 and 11040-11042. • 10-day services. These commonly include CPT codes 10060/10061, 11400-11446, 11600-11646, 17260-17285, all intermediate and complex repairs (12031-12057, 13100-13153) and 17000-17004. • 90-day services. These commonly include CPT codes that start with “14” or “15” (for example, flaps and grafts) and 17106-17108. Don’t forget, you and your staff should carefully check with your managed care contracted carriers to verify that your practice is adhering to Medicare guidelines. n Inga Ellzey, president/CEO of the Inga Ellzey Practice Group, Inc. in Casselberry, FL, is an expert on dermatology coding, documentation and reimbursement. She has more than 29 years experience in the field of dermatology and is also the CEO and founder of three nationwide dermatology billing services. You can phone her at (800) 318-3271 or e-mail her at

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