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Billing by specialty

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Specialty billing

General surgery billing services

General surgery billing is coding each operation from the operative note and billing the care around it within the procedure’s global period, with the modifiers that show which visits and procedures are paid on their own.

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Surgery

The global period bundles care

  1. Day beforedecision visit, 57
  2. Surgeryday 0
  3. 10 daysminor procedures
  4. 90 daysmajor operations
Inside it, a visit or procedure is paid only with the right modifier.

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Check a visit inside the global period

Inside a global period, a visit or procedure is paid only with the right modifier.

Inside the global period?

0 · 10 · 90 days

An operation, then a visit or a procedure some days later.

The operation’s global period
days
  • 24modifier

An unrelated visit inside the global period is paid with modifier 24.

The visit at which the decision for a major (90-day) operation is made, the day before or the day of surgery, takes modifier 57.

Why is surgical billing hard?

  • The global period bundles care

    Each surgical code has a global period of 0, 10 or 90 days. For a major operation, Medicare includes the visit the day before or the day of surgery and routine follow-up for 90 days in one payment.

  • Modifiers decide what is paid

    Inside a global period, a visit or procedure is paid only with the right modifier: 57 for the decision for surgery, 24 for an unrelated visit, 58 for a staged procedure, 78 for an unplanned return to the operating room and 79 for an unrelated procedure.

  • Multiple procedures and edits

    When several procedures are done in one session, payers pay the second and later ones at a reduced rate, and NCCI edits bundle a procedure that is part of another unless the note supports modifier 59 or an X modifier.

  • The operative note decides the code

    The approach, the size and depth, and what was repaired or removed all change the CPT code, so codes come from the operative note, not from the procedure that was scheduled.

  • Assistants and co-surgeons

    An assistant surgeon (modifiers 80, 82 or AS) is paid only for procedures the payer allows assistants on, and co-surgeons (modifier 62) each need their own operative note.

What Beeline handles for surgical practices

General surgery billing questions

What is a global surgical period?
The time around an operation whose routine care is paid as part of the surgery: 0 or 10 days for minor procedures and 90 days for major ones. For a major operation it includes the visit the day before or the day of surgery and the routine follow-up visits.
What is the difference between modifier 25 and modifier 57?
Both mark a visit on the same day as a procedure as paid on its own. Modifier 57 is for the visit at which the decision for a major (90-day) operation was made, the day before or the day of surgery. Modifier 25 is for a significant, separate problem treated on the same day as a minor procedure.
When are modifiers 78 and 79 used?
During a procedure’s global period. 78 is for an unplanned return to the operating room for a related procedure, such as treating a complication; 79 is for a procedure unrelated to the first surgery. A 78 procedure doesn’t start a new global period; a 79 procedure does.

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