4 Factors of Surgical Billing Success

Whenever medical facilities are reimbursed for any kind of surgical procedure, it falls under the concept of what is known as the Global Surgical Package. This includes all services which are deemed medically necessary with regard to the surgical procedure, and it is observed by Medicare, Medicaid, and all third-party insurers.

QUICK LINK: Global Surgery Booklet PDF Download

Whether the services are considered to be incidental to the actual surgery, or whether they are considered integral to the process, they are covered under this Global Surgical Package concept. Thus, the evaluation, management, and all physical interventions associated with the surgery are included and will be reimbursed under the GSP package. The most important factors for coding these procedures correctly and achieving surgical billing success are described below.

Identifying the surgical Period

There is a global period defined for every Healthcare Common Procedural Coding System (HCPCS) code, and this period can be anywhere from zero to 10 days following what is considered to be a minor surgical procedure, and up to 90 days when major surgery is involved. Any procedure performed during this Global Surgical Period is considered to be integral to the process, and can successfully be claimed on billing forms.

The amounts which are approved for these claims will depend on all the elements which were necessary in order to complete the service. This will include all visits to the surgeon after an initial decision was made to operate. In effect, the Global Surgical Period begins on the day that surgery is performed for minor surgeries and the day before surgery for major operations.

Listing intra-operative services

All services performed by the surgeon are considered by the GSP to be important processes and can be billed for surgery. Even evaluation of the patient is billable, but – none of the processes related to surgery should be billed separately. Everything which happens while the surgery is being performed is considered to be included in the billing for surgery.

Also, any complications which arise as a result of surgery are considered to be part of the surgical process, and likewise do not require any separate billing codes. Thus, any complications which arise during the 90 days of a Global Surgical Period for a major operation are treated as part of the surgery, and any complications which arise within the 10 days of the GSP for minor surgery are considered part of that surgery billing.

Including necessary supplies

Any surgical supplies used by the surgeon to perform the procedure are billable also and should be coded up using the appropriate HCPCS code. Examples of such supplies would include catheters, dressings, suture materials, casts, drains, and anesthesia materials, assuming that a separate anesthesiologist was not used. Any follow-up procedures are done after surgery, e.g. removal of catheters, would not be coded separately on a billing claim since they would be considered part of the procedure itself.

Excluding non-GSP factors

There are some elements related to surgery which are not included in the Global Surgical Package, and for this reason, they must not be coded on to billing forms, or there is a good possibility that the claim will be denied. Right at the very beginning of the process is one good example. The very first consultation, at which it is decided that surgery will be needed, is not included in the GSP, although every consultation afterward would be included. Once it has been determined that surgery will be necessary, all further consultations are included in the GSP.

It is also possible for a patient to exhibit symptoms while within the Global Surgical Period, which are unrelated to the surgery itself or the condition which is necessitating surgery – these cannot be claimed on a billing form. They may indeed be claim-able as standalone procedures, but they cannot be claimed under the Global Surgical Package, and they would not be honored if listed. There are also no kinds of diagnostic tests or procedures which can be included in the GSP, nor can peripheral surgical procedures be claimed, which are not part of the main procedure.

If you follow the guidelines identified above, you should have no trouble with billing your surgical procedures and having them honored by insurance carriers. With a little attention to detail and some knowledge of what is allowed and what is not, you should have smooth billing operations for all your surgical procedures.