Postoperative Periods
The difference between major and minor surgical procedures is reflected in the number of follow-up (postoperative) days after the surgery.
The Medicare Physician Fee Schedule Data Base (MPFSDB) will show the exact number of postoperative days associated with each procedure. The number of global days associated with a procedure can be found under the “GLOB DAYS” column in the MPFSDB. Postoperative periods are generally designated as follows:
Procedure Global Period
Major 90
Minor 0 or 10
Endoscopic 0
A surgery with 90 follow-up (postoperative) days is considered a major surgery.
A surgery with zero to 10 follow-up (postoperative) days is considered a minor surgery.
Some procedures in the surgical CPT range are strictly diagnostic (such as some endoscopies) and may not involve actual surgery. Most of these have “zero” follow-up days and include an allowance for the normal pre- and postoperative care associated with the procedure.
Note: See more information on billing minor surgeries and office visits under the 25 modifier.
POST-OPERATIVE PERIOD BILLING
Unrelated Procedure or Service or E/M Service by the Same Physician During aPost-operative Period
Two CPT modifiers are used to simplify billing for visits and other procedures that are furnished during the post-operative period of a surgical procedure, but not included in the payment for surgical procedure. These modifiers are:
• Modifier “-79” (Unrelated procedure or service by the same physician during a post-operative period). The physician may need to indicate that a procedure or service furnished during a post-operative period was unrelated to the original procedure. A new post-operative period begins when the unrelated procedure is billed.
• Modifier “-24” (Unrelated E/M service by the same physician during a post-operative period). The physician may need to indicate that an E/M service was furnished during the post-operative period of an unrelated procedure. An E/M service billed with modifier “-24” must be accompanied by documentation that supports that the service is not related to the post-operative care of the procedure.
Return to the OR for a Related Procedure during the Post-Operative Period
When treatment for complications requires a return trip to the operating room, physicians bill the CPT code that describes the procedure(s) performed during the return trip. If no such code exists, the physician should use the unspecified procedure code in the correct series, which is, 47999 or 64999. The procedure code for the original surgery is not used except when the identical procedure is repeated.
In addition to the CPT code, physicians report modifier “-78” (Unplanned return to the operating or procedure room by the same physician following initial procedure for a related procedure during the post-operative period).
The physician may also need to indicate that another procedure was performed during the post-operative period of the initial procedure. When this subsequent procedure is related to the first procedure, and requires the use of the operating room, this circumstance may be reported by adding the modifier “-78” to the related procedure.
NOTE: The CPT definition for modifier “-78” does not limit its use to treatment for complications.
Staged or Related Procedure or Service by the Same Physician During the Post-operative Period
Modifier “-58” (Staged or related procedure or service by the same physician during the post-operative period) was established to facilitate billing of staged or related surgical procedures done during the post-operative period of the first procedure. Modifier “-58” indicates that the performance of a procedure or service during the post-operative period was:
• Planned prospectively or at the time of the original procedure
• More extensive than the original procedure
• For therapy following a diagnostic surgical procedure
Modifier “-58” may be reported with the staged procedure’s CPT. A new post-operative period begins when the next procedure in the series is billed.
