Global modifier

Imagine you want to go on vacation to an exotic tourist resort but don’t want to get in the hassle of planning out every aspect of your trip on your own. You contact a travel agency and, based on your preferences such as the length of your trip and the places you want to visit, they plan out your trip and offer you an attractive travel package. This would include your commute, hotel rentals, cost of meals, and any other important overall costs.

As the healthcare industry progressively leans towards consumer-based and effective billing, the same model is employed for surgical procedures. To make billing easier, healthcare providers offer global surgical packages that encompass almost all the services you would require in such a predicament.

Like a travel package, the global surgical package would only cover all reasonable needs. Healthcare providers use the global surgery modifiers to account for any changes or add-ons in the surgical proceedings.

Now that you know the crux behind global surgical packages, let’s discuss what they are exactly, and delve into a simple and usable summary of the global modifiers used to customize global surgical packages to each patient uniquely.

What is a global surgical package?

A global surgical package accounts for all the necessary and reasonable procedures you avail of before, during, and after a surgical service. This will include pre-surgical procedures, the surgery itself, post-operative procedures, and the recommended routine follow-up after a prescribed number of days.

The same surgeon or surgeons in the same specialty or group would provide all these services in a standard global surgical package. For example, a general surgeon could perform a mole-removal surgery on you, and someone else from their surgical group could tend to you in your follow-up appointment. It will still be accounted for as part of that same global surgical package.

There are three types of global periods that carry a global surgical package. These are described below.

Global periods

The global period is the number of days (pre-, intra-, and post-operative) that a global surgical package encompasses. It can vary depending on the type of surgery you have undergone. That is, the bigger or more serious the surgery, the more days of follow-up care you will require.

– The first type is a 0-day global period when you have undergone a minor procedure such as an endoscopy that will not require a follow-up appointment. There are no pre-or post-operative days. The global package only applies on the day of the procedure or service.

If you visit the hospital regarding the procedure post-operatively, it will be billed separately from the surgical procedure, potentially as a separate E/M service. In short, you will be billed for the surgical procedure singularly, and any other services will be billed separately.

– The second type is the 10-day global period for minor surgeries, such as mole removal. A follow-up will be required to open the sutures and ensure the incision isn’t infected. This global package accounts for the ten days following the day of the surgery.

– Lastly, we have the 90-day global period for major surgeries, like a bone replacement, that require intensive post-operative care. Technically, it is a 92-day global period, including one day pre-operative, the day of the surgery, and 90 post-operative days.

Global billing services

What does a global surgery package include?

The global surgical package for these global periods includes:

  • All the pre-operative care after the decision for surgery is made, such as filling out paperwork
  • Pre-operative care on the day of surgery
  • Intra-operative procedures
  • Post-operative procedures, treatment of complications, pain management, suture removal, etc.
  • Supplies used in the treatment of post-operative complications

It does not include:

  • Any diagnostic procedures/tests
  • The decision for surgery, in the case of major surgeries with a 90-day global period
  • Complications that require a return to the OR
  • Any other medical treatments/procedures that are not related to the surgery, such as an unrelated chronic condition

What are global surgery modifiers? 

Now that we have a clear idea of what global surgical packages include and exclude, we appreciate the need for global modifiers in billing.

Global modifier codes are add-on billing codes to specify service billing further when all the criteria for a standard global surgical package are not met. Maybe the provider performed the surgery, but the patient received post-operative care from elsewhere due to the transfer of care. Providers will then list a global surgery modifier to collect the appropriate payment for the percentage of service they specifically provided or to account for any additional services that are not part of a standard global surgical package.

Global modifier

Modifiers explained 

Each modifier listed below is followed by a brief and useful explanation of its usage.

– No pre-operative care
– Surgical care only
– No post-operative care

– No pre-operative care
– No surgical care
– Post-operative care only

– Pre-operative care only
– No surgical care
– No post-operative care

– Can only be billed for major surgical procedures (90-day global period procedures)
– Modifier 57 is used to account for the decision for surgery, which is not included in the global surgical package

– Planned/staged return to the OR in the global post-operative period
– For a related procedure
– Procedure performed by the same physician or another physician from the same group

– Unplanned return to the OR in the global post-operative period
– For a related procedure
– Procedure performed by the same physician or another physician from the same group

– Return to the OR in the global post-operative period
– For an unrelated procedure
– Procedure performed by the same physician or another physician from the same group
– A new post-operative period is initiated when this procedure is billed

– Unrelated E/M service provided in the global post-operative period
– Procedure performed by the same physician or another physician from the same group

– Unrelated E/M service, surgical procedure, diagnostic tests, etc. performed on the same day of another billed service
– Procedure performed by the same physician or another physician from the same group

– Indicates that two primary surgeons were involved in the performance of the surgery
– Each physician must document the performance of each distinct procedure within the surgery that they performed

– Indicates that a surgical assistant was involved in the surgery
– The primary surgeon’s documentation indicating the involvement of the assistant-at-surgery is sufficient for the application of this code

For more details, you can visit the WPS Government Health Administration website or read the

CMS Global Surgery Booklet to further understand global billing.


A 4-year-old reports to the OR with a 2 cm laceration on the lateral side of the left wrist. The physician sutures the laceration. During the same visit, the child’s mother consults the physician about her child’s asthma. The physician adjusts his asthmatic medication and performs a child’s physical examination.

The physician performed minor surgery and an unrelated E/M service in this case. Modifier -25 will apply to the CPT code here.

See Also: The Impact Of Vertical Integration In Healthcare


Using billing modifiers can be confusing, but with the help of examples and the explanations above, you will understand medical coding better. It is important to understand the intricacies of medical coding to ensure each process is documented for and reimbursed effectively, leaving no room for doubt or confusion.

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