Explain the global surgical package and its impact on coding.

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What Is the Global Surgical Package?

The global surgical package (sometimes called a surgical global period) is a bundled payment system used by CMS (Centers for Medicare & Medicaid Services) and many insurers. It covers services before, during, and after surgery for a defined time period: typically 0-, 10-, or 90-day global periods depending on how major the surgery is.

Included in a global package are:

• Pre-operative visits (usually starting day before for major surgeries, or day of for minor)

• The operation itself

• Routine postoperative visits and care, plus management of certain complications (that do not require return to operating room) during that global period.

Excluded are services unrelated to the surgery (co-morbid conditions, diagnostic tests not related, etc.), or additional surgery if required beyond what was originally planned.

Why the Global Surgical Package Matters in Medical Coding

For students in a medical coding course, understanding global surgery packages is essential because:

1. Billing accuracy: Coders must know what can and cannot be billed separately during the global period, what modifiers apply (e.g., modifier -54 “Surgical Care Only” when the surgeon only performs the operation but not follow-up care).

2. Reimbursement impact: Because services are bundled, under-reporting or mis-applying the global rules can lead to lost revenue or audit risk.

3. Data valuation & policy changes: CMS and other bodies use claims and data about post-operative visits to reassess global codes. For example, a RAND study showed that of the 457,256 procedures with 90-day global periods studied between July 2017 and June 2018 in nine states, about 70.9% had one or more post-operative visits reported. In contrast, for 10-day global period procedures, only 3.7% of 961,006 procedures had any post-operative visits reported. That mismatch between “expected” and “observed” visits is being used to rethink how global surgical services are valued.

4. Coding modifiers and add-on codes: New rules (e.g. for 2025) expanded use of modifier -54 (even for informal transfer of care) and introduced an add-on code G0559 for postoperative follow-ups by providers other than the operating surgeon. These affect how you code properly.

Stats That Show the Change

• Procedures with 10-day global periods: only ~3.7% had any post-operative visits reported in clean procedures in the sample.

• Procedures with 90-day global periods: ~70.9% had at least one post-operative visit reported.

• For many specialties (hand surgery, orthopedics, urology, ophthalmology etc.), over 90% of practitioners reported some postoperative visits in the nine-state data collection.

These gaps show there is often under-reporting of postoperative care for short global periods, and that policy makers are shifting coding rules to reflect what is actually done. That leads to coding, auditing, billing changes.

How This Affects Students in a Medical Coding Course

As you train in medical coding, knowing the global surgical package means:

• Learning the rules for what’s included/excluded, so you can code appropriately.

• Understanding relevant modifiers (like -54) and new codes (e.g. G0559) so you can correctly represent services in claims.

• Recognizing that accurate reporting of post-operative visits influences how global codes are valued in the future (including RVUs, relative value units).

This knowledge makes you more employable and helps reduce billing errors, denials, or compliance issues.

Quality Thought’s Role: Helping You Master This

At Quality Thought, we believe in delivering quality education. In our medical coding courses, we:

• Teach global surgical package rules with real-world examples & case studies, including updates like modifier -54 and G-codes.

• Use data from studies (like the RAND reports, CMS MPFS rulings) to show you how coding policy changes evolve over time.

• Provide hands-on practice coding surgical cases with global periods, plus reviewing pitfalls and auditing scenarios.

• Offer support in understanding payer policies, since not all payers follow CMS rules exactly (private insurers may differ).

This helps educational students build both strong theoretical knowledge and practical coding skills.

Conclusion

The global surgical package is a crucial concept in medical coding—it bundles pre-, intra-, and post-operative services into defined periods, creating specific coding & billing rules that affect reimbursement, audit risk, and care valuation. Studies show that what’s assumed in global packages (e.g. number of post-operative visits) doesn’t always match real-world reported practice, which is driving policy changes like modifier expansions and new add-on codes. As medical coding students, mastering these rules will be a key part of your competency. With Quality Thought’s courses, you’ll gain clarity, up-to-date knowledge, and practice so you can code globally with confidence—are you ready to dive deeper and shape your future as a coding professional?

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