Guidelines for Pre- and Postoperative Care Coding Billing Form

GUIDELINES FOR PRE- AND POSTOPERATIVE CARE CODING AND BILLING COMPREHENSIVE EDUCATIONAL RESOURCE Pre - and Postoperative Care & Global Periods Overview Global billing is critical for compliance, accurate reimbursement and fraud prevention. It bundles preoperative, intraoperative and postoperative services into one payment, reducing administrative burden and minimizing claim denials. Proper understanding of global periods ensures that providers avoid billing errors, maintain payer trust and streamline workflows. By adhering to these rules, practices can prevent costly audits and improve revenue cycle efficiency. Beyond compliance, global billing plays a key role in reducing duplicate claims, preventing overpayments and ensuring transparency in surgical care. It also helps providers align with CMS and commercial payer requirements, which is essential for avoiding penalties and maintaining financial stability. Definition of Pre/Postoperative Care Pre/Postoperative Care encompasses all medical services provided to a patient before and after a surgical procedure to ensure safety and optimal recovery.

• Preoperative care includes activities such as patient assessments, diagnostic tests, risk evaluations and preparation for

 anesthesia or surgery. These steps help identify potential complications and optimize the patient’s condition prior to

the procedure.

• Postoperative care focuses on monitoring the patient’s recovery, managing pain, preventing infections and addressing

 complications that may arise after surgery. This care is critical for reducing risks, improving outcomes and supporting the

patient’s return to normal function. What Are the Global Period Durations

PROCEDURE TYPE GLOBAL PERIOD INCLUDED SERVICES Minor procedure 0 days Day of surgery only Intermediate procedure 10 days Surgery + 10 days post-op Major procedure 90 days 1 day pre-op + surgery + 90 days post-op ~AULTCARE

Detailed Modifier Usage: When and How to Code Compliance Best Practices

• Verify global period for each payer before submitting claims.

• Use correct modifiers with supporting documentation.

• Maintain accurate global period tracking in your billing system.

• Document medical necessity for all non-global services. Common Denial Reasons

• Bundled services billed separately: Attempting to bill for services already included in the global package

• Incorrect modifier usage: Applying the wrong modifier or omitting necessary modifiers

• Failure to track global periods: Billing outside the allowed timeframe or overlapping global periods

• Diagnostic tests billed incorrectly: Tests related to the surgery billed separately without justification Summary This guide provides clear, practical instructions for coding and billing pre- and postoperative care within the global surgery period. It explains global period durations, defines included and excluded services and details proper modifier usage to ensure compliance and accurate reimbursement. By following best practices, such as verifying global periods, applying correct modifiers and maintaining thorough documentation, providers can reduce claim denials, prevent billing errors and support financial integrity. MODIFIER DESCRIPTION REASON TO APPLY 24 Unrelated E/M during global period E/M for unrelated condition during global period 55 Postoperative management only Another provider assumes post-op care 56 Preoperative care only Provider performs only pre-op care 57 Decision for surgery E/M visit resulted in decision for major surgery 58 Staged procedure Planned or related procedure during global period 78 Return to OR for complication Patient returns for related complication 79 Unrelated procedure during global period Unrelated procedure performed during global period ~AULTCARE