Coping with Coding has been developed to provide you with educational articles focusing on common coding questions and issues facing many Urologists. 

Coding Tip: Know your Global Days
by Michael A. Ferragamo MD, FACS

The Global period, expressed in days, represents the postoperative days following a surgical procedure during which charges for services related to the surgery such as dressing changes and postoperative office visits are included in the surgical payment made by the carrier... the global fee. This global fee includes a portion of the fee for pre- and postoperative care and a portion for the surgery itself. For most urological procedures 9% of the global fee is allotted to the preoperative evaluation, 16% for postoperative care, and the rest, about 75%, for the surgical procedure. Both CPT and Medicare recognize three global periods, 0, 10, and 90 days. Zero day global and 10 day global follow minor procedures and 90 day global most major procedures.

Procedures with zero day globals for which all postoperative care is payable after the day of surgery include cystoscopy, 52000, urethral dilations,53660-53665, and catherizations, 51701 -51703, to mention a few. Procedures with 10 day globals would include circumcision, 54161, and percutaneous cystostomy,51010. Radical or simple nephrectomies, 50220, 50230, radical prostatectomy, 55840-55845, TURP, 52601, and minimally invasive laser prostatic procedures, 52647, 52648, have 90 day globals.

Services or procedures performed in a global period are not payable except under special circumstances with the use of modifiers when payments may then be allowed (we will discuss use of modifiers at another time). However, there are two frequently performed urological procedures considered by most urologists as major procedures that in fact have zero day globals, an exception to the above rules. Many urologists are unaware that all codes for a TURB, 52224, 52234, 52235, 52240, as well as all CPT codes for ureteroscopic procedures, 52351-52355, have zero day globals. These unusual coding edits allow billing and payments of all postoperative services following these procedures. These payment decisions hold true for Medicare as well for most private/commercial insurance carriers.As an example:if a patient having a large TURB, 52240, or a difficult ureteroscopic stone extraction, 52352, or fragmentation, 52235, requires hospitalization after the procedure, all follow up hospital visits are billable and payable. No modifiers are required for payment. Bill hospital visits, CPT codes 99231-99233, as well as 99238/99239 on discharge from the hospital. Remember also all postoperative visits or services provided in the office after a TURB or ureteroscopic procedures are billable and fully payable as described above. The urologist should conscientiously look to record these charges and not lose revenue to which he is entitled.

One can find the globals for all surgical procedures and other services on the Medicare web site (www.cms.hhs.gov) or in publications such as the Part B Coding Hand Book, DecisionHealth, www.decisionhealth.com, telephone- 887-602-3835, from the AUA, www.codingtoday.com , and from the Physicians Reimbursement Service, in their Urology Source Book, 800-574-1936. The later is an excellent coding source for urology.

Michael A. Ferragamo MD is a practicing urologist and is the editor of Urology Coding Alert, a monthly newsletter on urology coding published by The Coding Institute of Naples, Florida. He is a nationally known coding expert in urology and would be happy to help with any coding problems you may have. He may be reached at the following numbers... 516-741-0118, 516-746-5550, 516-721-8149, fax 516-294-4736, or E-Mail Liqgold2@aol.com.