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.
Unrelated Evaluation and Management (E&M) services
The 24 Modifier may be appended to the CPT® code for an evaluation and management (E&M) addressing a problem that is unrelated to the one for which the patient is in a postoperative global period. As the 24 Modifier requires addressing a problem that is unrelated to the one for which the patient is in a postoperative global period, it is inappropriate to use this modifier when addressing a complication of the procedure for which the patient is in the global period.
Related Procedures
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 represented 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.
Unrelated Procedures
The 79 Modifier may be used for procedures unrelated to the problem for which the patient is in a postoperative global period without consideration of the place of service.
Staged Procedures
The 58 modifier may be used 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. Where the procedure takes place does not play a role in 58 Modifier use eligibility.
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
Dr. Jeffrey D. Lehrman, DPM, FASPS, MAPWCA, CPC, CPMA
Dr. Lehrman is a podiatrist practicing in Fort Collins, CO and operates Lehrman Consulting, LLC which provides consultation services regarding coding, compliance and documentation. Dr. Lehrman is a Certified Professional Coder and Certified Professional Medical Auditor. He serves as a staff liaison at the AMA CPT® Editorial Panel meetings where CPT codes are created, edited, and deleted. He is a Diplomate of the American Board of Foot and Ankle Surgery, Fellow of the American Society of Podiatric Surgeons, and is recognized as a “Master” by the American Professional Wound Care Association. Dr Lehrman is a Fellow of the American Academy of Podiatric Practice Management, Past Director of the American Professional Wound Care Association Board of Directors, and is a Past Chairman of the Board of the American Society of Podiatric Surgeons. Dr. Lehrman is also on the editorial advisory board of the journal WOUNDS.
