Apply Global Surgical Rules - Certified Professional Coder CPC

1. The global surgical package for a major surgical procedure includes postoperative follow-up care for how many days following the date of surgery?
   Answer: 90 days Major surgical procedures carry a 90-day global period. This includes the day of surgery, the intraoperative period, and 90 days of postoperative follow-up. Minor procedures typically carry a 0-day or 10-day global period. Routine follow-up visits within the global period are bundled and not separately reportable.
2. The day before a scheduled open hernia repair, the surgeon sees the patient in the office to complete the preoperative history, physical examination, and discussion of the procedure. How is this preoperative visit reported?
   Answer: It is not separately reportable — it is included in the global surgical package The global surgical package includes the preoperative visit on the day before or the day of a major surgical procedure. This visit is bundled into the global period and is not separately reportable. Modifier -57 (Decision for Surgery) is used for the E/M visit on the day before or day of surgery when the decision to perform the surgery is made at that visit — that scenario represents a separately identifiable decision-making service.
3. A patient presents to her surgeon for a new, unrelated problem during the 90-day postoperative period following a colectomy. The surgeon performs and documents a separately identifiable E/M service for the new complaint. Which modifier is appended to the E/M code?
   Answer: -24 Modifier -24 (Unrelated Evaluation and Management Service by the Same Physician or Other Qualified Health Care Professional During a Postoperative Period) is used when the E/M visit addresses a problem unrelated to the original surgery. This establishes the visit as separately billable despite occurring during the global period. Modifier -25 is for a separate E/M on the same day as a procedure, not during a postoperative period.
4. Which of the following is included in the global surgical package for a major procedure?
   Answer: Postoperative visits related to the surgery that occur within 90 days The global surgical package for major procedures includes: the day of surgery E/M (if related to the procedure), the intraoperative period, immediate postoperative care, and follow-up visits related to the surgery within the global period (90 days for major procedures). E/M for a new unrelated problem on the day before surgery, complications requiring a return to the OR (separately billed with -78), and truly unrelated procedures are excluded from bundling.
5. Under the global surgical package, which of the following intraoperative services is always bundled and never separately reportable?
   Answer: All of the above All of the listed services are components of the global surgical package when performed at the time of the primary procedure: drain placement in the operative field, graft harvesting, and cast/splint application are included in the primary surgical service and not reported separately. These are considered integral to the primary procedure and are already captured in the procedure's relative value.
6. A surgeon operates on a patient and discovers intraoperatively that the procedure is significantly more difficult than anticipated due to severe adhesions. The surgeon documents the additional complexity in the operative note. Can extra payment be claimed for the intraoperative complexity?
   Answer: Yes — modifier -22 is appended to the procedure code, and a special report documenting the increased complexity is submitted Modifier -22 (Increased Procedural Services) may be appended when the work required is substantially greater than typically required for the procedure. The surgeon must document the nature and extent of the increased complexity in a special report. The payer reviews the documentation and may authorize additional reimbursement. Without documentation, the standard fee applies.
7. A patient requires a planned second-stage surgical procedure during the 90-day global period of the initial surgery. The second stage was part of the original surgical plan. Which modifier is appended to the second-stage procedure code?
   Answer: -58 Modifier -58 (Staged or Related Procedure or Service by the Same Physician During the Postoperative Period) is used for a procedure performed during the postoperative period that was planned or anticipated at the time of the original procedure. This initiates a new global period. It differs from modifier -78 (return to OR for complication), which does not start a new global period.
8. A patient undergoes two separate surgical procedures on the same day by the same surgeon — a cholecystectomy and an inguinal hernia repair. Each procedure has its own 90-day global period. Do the global periods run concurrently or separately?
   Answer: Each procedure has a completely independent, non-overlapping global period beginning on the day of surgery Each surgical procedure initiates its own independent 90-day global period beginning on the date of surgery. When two procedures are performed on the same day, both global periods begin simultaneously and run concurrently. Follow-up care for each procedure is separately governed by its own global period, though in practice the visits are often addressed together.
9. A patient receives a routine postoperative follow-up visit at 3 weeks following a major surgical procedure. The surgeon documents a normal recovery with no complications. How is this visit reported?
   Answer: Not separately — routine postoperative follow-up is bundled into the global surgical package Routine postoperative follow-up care during the global period is included in the global surgical package and is not separately reportable. No additional E/M code is billed for a normal, uncomplicated postoperative visit. Separate billing is only appropriate when the visit addresses a new or unrelated problem (modifier -24), a complication requiring a procedure (modifier -78), or an unrelated procedure (modifier -79).
10. A surgeon sees a patient in the office and makes the decision to perform a major surgical procedure. The surgery is scheduled for the next day. Which modifier is appended to the office visit code to indicate this visit represented the decision for surgery?
    Answer: -57 Modifier -57 (Decision for Surgery) is appended to the E/M service at which the decision to perform a major surgical procedure is made, when that visit occurs on the day of or the day before the procedure. This modifier establishes the E/M as a separately identifiable service that triggered the surgical decision, preventing it from being bundled into the global period.
11. A procedure has a 0-day global period. A patient presents on the same day as the procedure with a separate, significant E/M issue. How is the E/M reported?
    Answer: With modifier -25, provided the E/M is a significant, separately identifiable service Even for procedures with a 0-day global period, a separately identifiable E/M service performed on the same day may be reported using modifier -25 if the E/M is beyond the pre-procedure evaluation and addresses a distinct clinical problem. The 0-day global period means there is no postoperative follow-up period, but same-day E/M bundling rules still apply.
12. A patient's colostomy was created during an emergency colectomy 4 weeks ago. The surgeon now performs a planned colostomy takedown and re-anastomosis. Which modifier applies to the colostomy reversal?
    Answer: -58 Modifier -58 (Staged or Related Procedure) is reported when the subsequent procedure was planned or anticipated following the original surgery, and both procedures are related. The colostomy takedown performed within the 90-day global period of the original colectomy/colostomy creation is a staged procedure. Modifier -58 is correct and initiates a new global period for the reversal procedure.
13. A patient is seen on the day of a minor surgical procedure (10-day global period) for a separate, significant E/M service addressing a new problem unrelated to the procedure. Which modifier is appended to the E/M code?
    Answer: -25 Modifier -25 (Significant, Separately Identifiable Evaluation and Management Service by the Same Physician on the Same Day of a Procedure or Other Service) is used when a separate E/M is performed on the same day as a procedure. It indicates the E/M service was beyond the pre-procedure assessment and addressed a different or newly identified problem. This is a same-day modifier, while -24 is used during the postoperative period.
14. A surgeon performs a total knee replacement (90-day global period) on October 1. On December 28 — 88 days later — the patient is seen for a routine postoperative check. Is this visit separately billable?
    Answer: No — the visit falls within the 90-day global period and is bundled The 90-day global period for a major surgical procedure begins on the date of surgery (October 1) and runs through December 30 (day 90). A visit on December 28 (day 88) falls within the global period and is therefore bundled as routine postoperative care. The visit is not separately reportable unless it addresses a new, unrelated problem (modifier -24) or involves an unrelated procedure (modifier -79).
15. A surgeon performs a procedure and later realizes it was more extensive than initially planned. The physician wants to bill modifier -22. Which of the following best justifies use of modifier -22?
    Answer: The operative report documents that the procedure required significantly greater technical work than typically required for the reported code Modifier -22 is justified only by documentation in the operative report that the intraoperative work was substantially greater than typically required — such as extreme obesity, severe adhesions, unusual anatomy, or excessive hemorrhage requiring additional effort. Extended OR time due to scheduling delays, extensive preoperative counseling, or increased post-op visits do not justify modifier -22. A special report must accompany the claim.
16. During the 90-day global period following a knee replacement, a patient requires a totally unrelated procedure — removal of a skin lesion on the arm. The original surgeon performs both follow-up and the lesion removal. Which modifier is appended to the lesion removal code?
    Answer: -79 Modifier -79 (Unrelated Procedure or Service by the Same Physician During the Postoperative Period) is used when an unrelated procedure is performed during the global period of a prior surgery. The skin lesion removal is unrelated to the knee replacement. Modifier -79 allows the additional procedure to be billed separately. A new global period is initiated for the unrelated procedure.
17. A surgeon performs a laparoscopic appendectomy. The following day, the patient is seen for a routine post-op check. Three days later, the patient presents with a post-op fever and is seen again. How are the two post-op visits reported?
    Answer: Neither visit is separately billable — both are bundled into the global surgical package Laparoscopic appendectomy carries a 90-day global period. Both the routine post-op check and the visit for a post-op fever (a complication being managed medically without a return to the OR) are bundled into the global period. Complications requiring only medical management — without a return to the OR — are included in the global package. Only complications requiring a new procedure in the OR (modifier -78) are separately reportable.
18. The surgeon who performed the original procedure is transferring the patient's postoperative care to another physician in the same practice. Which modifier does the original surgeon append to the procedure code to indicate this transfer of care?
    Answer: -54 Modifier -54 (Surgical Care Only) is reported by the surgeon who performed the procedure but will not be providing postoperative management. The receiving physician reports modifier -55 (Postoperative Management Only) to claim the postoperative care portion of the global fee. The global fee is divided between the two physicians based on the relative portions of care.
19. A surgeon who did not perform the original surgery assumes care of a patient during the postoperative global period due to the original surgeon's unavailability. How does the covering surgeon report postoperative follow-up visits?
    Answer: With modifier -55 (Postoperative Management Only) to identify assumption of postoperative care When a physician other than the surgeon who performed the procedure assumes postoperative care, the covering physician reports postoperative management using modifier -55 (Postoperative Management Only). The original surgeon reports modifier -54 (Surgical Care Only) to indicate they performed only the intraoperative portion. The global fee is then split between the two providers based on the applicable relative value units.
20. Which of the following services is explicitly EXCLUDED from the global surgical package and is always separately reportable?
    Answer: Initial consultation required prior to the decision for surgery Pre-surgical consultations or E/M services performed prior to the decision for surgery — before the global period begins — are separately reportable. The global surgical package does not include services rendered before the preoperative period (the day before/day of surgery for major procedures). Initial workup visits that preceded the surgical decision are outside the global period entirely.

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