Crystal's MCW Coder HubGenerally, no, you cannot bill an Evaluation and Management (E/M) code during a global period for routine post-operative care. Services related to recovery, such as removing sutures, changing dressings, or monitoring progress, are bundled into the surgical payment.
However, there are three specific exceptions where you can bill an E/M service during a global period if you use the correct modifier:
1 . The Visit is Unrelated to the Surgery (Modifier 24 )
If you treat the patient for a diagnosis entirely unrelated to the surgery (e.g., a patient with a recent hip replacement comes in for a sinus infection), you may bill the E/M code.
- Modifier: Append Modifier 24 to the E/M code .
- Requirement: The diagnosis code for the visit must be different from the surgical diagnosis to prove it is unrelated .
2 . Decision for Major Surgery (Modifier 57 )
If the E/M visit results in the initial decision to perform a major surgery (90-day global period) and occurs on the day of or day before the procedure, it is billable.
- Modifier: Append Modifier 57 to the E/M code .
- Restriction: This does not apply to minor procedures (0 or 10-day global periods). The decision to perform a minor procedure is bundled .
3 . Significant, Separate Service on Day of Minor Procedure (Modifier 25 )
If you perform a minor procedure (0 or 10-day global) and provide a significant, separately identifiable E/M service on the same day, you can bill it.
- Modifier: Append Modifier 25 to the E/M code .
- Requirement: Documentation must show the work went above and beyond the usual pre-operative and post-operative work associated with the procedure .
New for 2025 (Medicare): If you are a practitioner who did not perform the surgery (and are not in the same group) but are providing a post-operative follow-up visit without a formal transfer of care, you may be able to report the new add-on code G0559 .
Would you like to review the specific documentation requirements for Modifier 24 to ensure your “unrelated” visits don’t get denied?