Crystal's MCW Coder HubCan you bill an E/M code during a global period? Generally, 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,.
Unlike Modifiers 24, 25, and 57 (which are for E/M codes), Modifiers -58, -78, and -55 are used to describe how a surgical procedure or post-operative care relates to the global period.
Here is the breakdown of when to use each:
Modifier 58: Staged or Related Procedure
Use this on a procedure code when a second surgery is performed during the postoperative period of the first.
- Scenario: The second procedure was planned prospectively (staged), is more extensive than the original, or is therapy following a diagnostic procedure.
- Global Period: It starts a new global period.
- Payment: You generally receive 100% of the allowable amount.
Modifier 78: Unplanned Return to the Operating Room
Use this on a procedure code when the patient must return to the OR to treat a complication of the original surgery.
- Scenario: It must be an unplanned return to a specific “operating/procedure room” (e.g., OR, endoscopy suite, cath lab). It does not apply to procedures done at the bedside.
- Global Period: It does not start a new global period; the original calendar continues.
- Payment: You are paid only for the intra-operative portion (usually ~70-80% of the fee) because pre- and post-op care is already covered by the original surgery.
Modifier 55: Postoperative Management Only
Use this when there is a transfer of care (split care).
- Scenario: The surgeon performed the procedure (billed with Modifier -54) but transfers the patient to you for the post-operative recovery.
- Billing: You bill the surgical code with Modifier -55 and report the specific dates you assumed care.
- Payment: You receive a portion of the global fee designated for post-op management.
Quick Summary Table:
| Modifier | Use Case | Starts New Global Period? | Payment Impact |
|---|---|---|---|
| -58 | Planned / Staged Procedure | Yes | 100% of Allowable |
| -78 | Unplanned Return to OR (Complication) | No | Intra-operative % Only |
| -55 | Taking over Post-Op Care only | N/A (Part of original) | Post-op % Only |
Would you like to know about Modifier 79, which is used for an unrelated procedure performed during a global period?