What is included in the 90-day global surgical period in orthopedic surgery?
Under CMS and AMA guidelines, major orthopedic surgeries carry a 90-day global surgical package. This package bundles: pre-operative visits the day before or day of surgery, intra-operative procedures integral to the main service, standard local anesthesia, routine post-operative complications not requiring return to the operating room, and all routine post-operative follow-up visits within 90 days.
1. The High Financial Impact of Orthopedic Coding Accuracy
With major joint arthroplasties and multi-level spinal fusions generating thousands of dollars per case, a single coder error or missed add-on code can cause massive revenue leaks.
Furthermore, commercial payers actively scrutinize orthopedic and neurosurgical claims for unbundling and incorrect assistant surgeon billings.
2. Mastering Global Surgical Modifiers: 58, 78, and 79
When and how to legally unbundle post-op encounters
When a patient requires surgery or treatment during a 90-day global window, use the correct modifier:
• Modifier 58 (Staged or Related Procedure): Used when a second surgery was planned prospectively at the time of original surgery, or is more extensive than the initial procedure.
• Modifier 78 (Unplanned Return to the Operating Room): Used when complications (such as post-op hemorrhage or wound debridement) require returning to the OR.
• Modifier 79 (Unrelated Procedure by Same Physician): Used when an unrelated orthopedic issue arises (e.g., a patient having right knee arthroscopy who breaks their left wrist 3 weeks later).
3. Spine Surgery: Mastering Multi-Level Arthrodesis Coding
Spinal fusion coding requires separating the arthrodesis, instrumentation, bone grafting, and decompression.
For example: posterior lumbar interbody fusion (PLIF/TLIF) at L4-L5 utilizes primary code 22633. Additional vertebral levels must be billed using add-on code +22634 rather than billing 22633 multiple times.