How it works
Medicare assigns each procedure a global period of 0, 10 or 90 days. For major (90-day) procedures, the package includes the pre-operative visit the day before or the day of surgery, the surgery itself and routine follow-up care for 90 days afterward. Minor procedures have 0 or 10 days and include visits on the day of the procedure. Many commercial payers follow the same periods.
Why it matters
Routine post-operative visits are not billed separately — but some services in the global period are. Modifiers identify them: 24 for an unrelated visit, 25 for a significant separate service on the day of a minor procedure, 57 for the decision for major surgery, 58 for a staged or planned related procedure, 78 for a return to the operating room for a complication, and 79 for an unrelated procedure.
Example
Six weeks after knee surgery, the patient is seen for an unrelated shoulder problem. The visit is billed with modifier 24. See orthopedic billing.