Many wound care–related procedures, including some amputations and certain incision and drainage services, carry with them a 10 or 90-day postoperative global period. For most third-party payers, any care provided within that global period is included in the payment for the procedure and should not be separately submitted. However, there are some exceptions.
If a patient in a postoperative global period is seen in any setting with a complication of the procedure for which they are in the global period and an evaluation and management (E&M) of that complication is performed, there is no modifier that allows for payment of that E&M. The only E&M modifier that can be used during a postoperative global period is the 24 modifier, which is only appropriate when the E&M is for a problem unrelated to the one for which the patient is in the global period.
If a related, unplanned procedure is performed during a postoperative global period, it can be submitted for payment if it was performed in an operating / procedure room. This is representing by appending a 78 modifier to the CPT code. Procedures related to the problem for which the patient is in a postoperative global period (even a debridement of an unplanned, postoperative complication) should not be submitted if not performed in an operating / procedure room. The only modifier appropriate for procedures performed somewhere other than an operating / procedure room during the global period is the 79 modifier, which is reserved only for procedures unrelated to the one for which the patient is in a postoperative global period.
The exception to this is the use of the 58 modifier, which is for procedures during the global period that are planned or anticipated (staged), more extensive than the original procedure, or for therapy following a surgical procedure.
References:
- 2022 CPT Professional. Current Procedural Terminology (CPT®) is copyright 1966, 1970, 1973, 1977, 1981, 1983-2021 by the American Medical Association. All rights reserved. CPT is a registered trademark of the American Medical Association (AMA).
- National Correct Coding Initiative Policy Manual For Medicare Services https://www.cms.gov/Medicare/Coding/NationalCorrectCodInitEd
