Certified Professional Coder (CPC) Quiz: Apply Global Surgical Rules
20 questions · exam conditions
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Apply Global Surgical RulesQuestion 1 of 20

Which of the following services is explicitly EXCLUDED from the global surgical package and is always separately reportable?

Intraoperative services integral to the primary procedure
Complications requiring a return to the operating room
Treatment of complications that do not require a return to the OR
Initial consultation required prior to the decision for surgery
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Certified Professional Coder (CPC) Quiz

Certified Professional Coder (CPC) Quiz: Apply Global Surgical Rules

Practice Apply Global Surgical Rules in Certified Professional Coder (CPC) with focused quiz questions that help you check what you know, review explanations, and build confidence with test-style prompts.

What this quiz covers

This quiz focuses on Apply Global Surgical Rules, giving you a quick way to practice the rules, question types, and explanations that matter most for Certified Professional Coder (CPC).

How to use this quiz

Try each quiz question before looking at the correct answer. Use the explanations to review missed ideas, then come back to similar questions until the pattern feels familiar.

All questions

Question 1

Which of the following services is explicitly EXCLUDED from the global surgical package and is always separately reportable?

  1. Intraoperative services integral to the primary procedure
  2. Complications requiring a return to the operating room
  3. Treatment of complications that do not require a return to the OR
  4. Initial consultation required prior to the decision for surgery (correct answer)
Explanation: 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.

Question 2

A surgeon performs a biopsy with a 10-day global period. Five days later, based on the biopsy results, the surgeon performs a definitive excision. How is the definitive excision reported?

  1. With modifier -79, as an unrelated procedure during the global period
  2. With modifier -58, as a staged procedure during the global period (correct answer)
  3. Without a modifier — the global period has no impact on a subsequent definitive procedure
  4. With modifier -24, as an unrelated service during the global period
Explanation: Modifier -58 is applied to the definitive excision when it is performed during the global period of the diagnostic biopsy and was anticipated or planned as a follow-up to the biopsy result. The excision is a staged related procedure — the biopsy was step one, and the excision is step two. Modifier -58 initiates a new global period for the excision.

Question 3

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?

  1. As a billable E/M visit, as all post-op care is separately payable
  2. Not separately — routine postoperative follow-up is bundled into the global surgical package (correct answer)
  3. As a billable visit with modifier -24
  4. As a billable visit with modifier -25
Explanation: 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).

Question 4

Which of the following is included in the global surgical package for a major procedure?

  1. E/M visits on the day before surgery for evaluation of a new, unrelated problem
  2. All complications requiring medical management, including those requiring a return to the OR
  3. Writing orders, interpreting test results, and reviewing records on the day of surgery
  4. Postoperative visits related to the surgery that occur within 90 days (correct answer)
Explanation: 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.

Question 5

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?

  1. -58 (correct answer)
  2. -78
  3. -79
  4. No modifier needed — the global period has expired
Explanation: 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.

Question 6

The global surgical package for a major surgical procedure includes postoperative follow-up care for how many days following the date of surgery?

  1. 10 days
  2. 30 days
  3. 60 days
  4. 90 days (correct answer)
Explanation: 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.

Question 7

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?

  1. As a separately billable E/M service with modifier -57
  2. It is not separately reportable — it is included in the global surgical package (correct answer)
  3. As a separately billable E/M service with modifier -25
  4. As a separately billable preventive medicine visit
Explanation: 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.

Question 8

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?

  1. Yes — the surgeon automatically receives additional payment for complex cases
  2. Yes — modifier -22 is appended to the procedure code, and a special report documenting the increased complexity is submitted (correct answer)
  3. No — all intraoperative complexity is included in the base procedure code
  4. Yes — modifier -62 is added to reflect the additional surgical work
Explanation: 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.

Question 9

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?

  1. It is always bundled — same-day E/M is never separately reportable
  2. With modifier -25, provided the E/M is a significant, separately identifiable service (correct answer)
  3. With modifier -57, since the E/M relates to a procedural decision
  4. With modifier -24, since it occurs within the global period
Explanation: 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.

Question 10

A surgeon begins a procedure but terminates it after the patient is prepped and anesthesia administered due to a sudden medical emergency. The procedure is rescheduled. Which modifier is reported on the discontinued procedure?

  1. -52
  2. -53 (correct answer)
  3. -73
  4. -74
Explanation: Modifier -53 (Discontinued Procedure) is reported by the physician when a procedure is terminated after the patient has been prepared and anesthesia has been administered, due to extenuating circumstances or a risk to the patient's well-being. No global period is initiated when a procedure is discontinued. The rescheduled, completed procedure begins a new global period when performed.

Question 11

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?

  1. Each procedure has a completely independent, non-overlapping global period beginning on the day of surgery (correct answer)
  2. The global periods merge into a single 90-day period shared by both procedures
  3. Only the primary procedure carries a global period; the secondary procedure's period is waived
  4. The global period for the secondary procedure does not begin until the first procedure's period ends
Explanation: 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.

Question 12

A physician provides preoperative clearance for a patient scheduled for surgery by another surgeon. The clearance visit was initiated by the surgeon, not the patient. How is this preoperative consultation reported?

  1. As a consult code (99241–99245) if the payer recognizes consult codes
  2. As an office visit (99202–99215) since Medicare does not recognize consult codes
  3. As a preoperative examination using Z01.810 or Z01.818
  4. All of the above may be appropriate depending on the payer and context (correct answer)
Explanation: Preoperative clearance visits are reported as either consultation codes (for non-Medicare payers that recognize them) or as an appropriate office/outpatient E/M code (for Medicare). The ICD-10-CM first-listed diagnosis is the pre-procedural examination code (Z01.810 for cardiovascular; Z01.818 for other pre-op exams). The approach varies by payer policy, and the underlying condition requiring surgery is coded as an additional diagnosis.

Question 13

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?

  1. Yes — visits after day 60 are always separately billable
  2. No — the visit falls within the 90-day global period and is bundled (correct answer)
  3. Yes — visits after October 31 are outside the global period
  4. Yes — only the first 30 days of postoperative care are bundled
Explanation: 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).

Question 14

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?

  1. The covering surgeon cannot bill for postoperative care within another surgeon's global period
  2. With modifier -55 (Postoperative Management Only) to identify assumption of postoperative care (correct answer)
  3. With modifier -54 (Surgical Care Only) on the original procedure code
  4. With modifier -24 to indicate an unrelated provider is assuming care
Explanation: 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.

Question 15

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?

  1. Both visits are separately billable — each complication visit is always reportable
  2. Neither visit is separately billable — both are bundled into the global surgical package (correct answer)
  3. The routine check is bundled; the fever visit is separately billable with modifier -24
  4. The routine check is separately billable; the fever visit is bundled into the global package
Explanation: 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.

Question 16

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?

  1. -25
  2. -57
  3. -24 (correct answer)
  4. -58
Explanation: 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.

Question 17

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?

  1. -76
  2. -77
  3. -78
  4. -58 (correct answer)
Explanation: 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.

Question 18

Under the global surgical package, which of the following intraoperative services is always bundled and never separately reportable?

  1. Harvesting of a graft from a separate site
  2. Insertion of a drain in the same operative field as the primary procedure
  3. Application of a cast or splint following an orthopedic procedure
  4. All of the above (correct answer)
Explanation: 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.

Question 19

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?

  1. -24
  2. -25 (correct answer)
  3. -57
  4. -79
Explanation: 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.

Question 20

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?

  1. -55
  2. -54 (correct answer)
  3. -56
  4. -62
Explanation: 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.