In orthopedic billing, the surgery department is more complex than others. In surgery billing, billers handle global periods during claims processing. These periods directly affect how providers bill for procedures, how payers reimburse claims, and how practices manage revenue. They prepare surgical packages that include all services performed on patients. In this way, surgeons and healthcare providers also receive their payments for global periods.
If your practice struggles to manage these billing complexities, professional orthopedic billing services can ensure accuracy, compliance, and faster reimbursements.
In this article, we will explain the impact of orthopedic surgery on global periods in medical billing. We will discuss the duration of these periods with CMS guidelines for effective billing. Moreover, we will suggest a top-notch billing company, SysMD, for handling complex surgery packages for the global periods of your hospital.
What Are Orthopedic Surgery Global Periods?
In orthopedics, every surgery takes a different amount of time from evaluation to post-operative care. All the services from evaluation to surgery and post-surgical care fall under global periods. Similarly, every surgical procedure has a different global period.
If you’re wondering what are orthopedic billing services and how they relate to global periods, they include managing these bundled timelines—ensuring each phase of patient care is billed accurately and according to CMS rules.
The Centers for Medicare & Medicaid Services (CMS) set the time frame for orthopedic surgery global periods. These time periods define the services included in a surgical global package. Usually, global periods apply to common procedures such as joint replacements, fracture repairs, and arthroscopies.
After performing a procedure, CMS assigns a period of 0, 10, or 90 days. For example:
- 0-day global period – Includes only services on the day of surgery.
- 10-day global period – Includes services on the day of surgery and routine follow-up for 10 days.
- 90-day global period – Includes pre-op, the surgery itself, and all routine post-op care for 90 days.
Why Global Periods Matter in Orthopedic Surgery
Hospitals or surgeons receive payment for all services in a global package.
Global periods benefit both healthcare organizations and patients. That is why all billing systems should adopt these models. CMS also encourages the utilization of these packages in surgical routines. When hospitals do not offer global period packages where necessary, payers often reject these claims.
Some major benefits of orthopedic surgery in global periods are as follows:
Revenue Improvement
In global packages, billers prepare a bundle in which they list all the services of a specific period separately. This strategy prevents mixed or “bundled” billing, which can cause confusion and financial issues for hospitals. On the other hand, separate billing for every service within a day streamlines the entire billing process.
Compliance Maintenance
According to CMS billing guidelines, hospitals should bill surgical services in the form of global periods. Hospitals that fail to follow this policy will face compliance issues. Ultimately, it affects the reputation of the orthopedic surgery department.
Patient Satisfaction
Patients usually want to know the details of the services they received because they often do not understand what they are paying for. In global period billing, billers list all service details—from minor to major. This transparency provides patient satisfaction and prevents surprise bills.
Explanation of a Surgical Package
A surgical package is similar to bundled billing. Instead of billing separately for every service, the surgeon receives a single payment for the complete surgery and treatment. In this package, billers combine all the service charges into one payment.
In orthopedic surgery, the surgical package includes:
- Preoperative visits – Usual evaluation before surgery.
- Intraoperative services – The actual procedure.
- Postoperative visits – Follow-up care during the global period.
This bundling simplifies payment but can create confusion in orthopedic billing, especially when practices do not clearly understand the details of all services. Moreover, insurance and payer companies may not see the breakdown of services, which can cause problems during reimbursement.
Postoperative Visits and Their Role
Postoperative visits are an important part of orthopedic recovery. For example, a patient who has hip replacement surgery will need a series of checkups to monitor recovery, remove stitches, or adjust treatment. During the global period, surgeons do not charge extra for these visits—they are included in the overall package.
Surgeons cannot charge for individual visits that fall within the normal follow-up of the operation. However, providers can bill separately for services that are not included in the package or are unrelated to the surgery. These services should always be documented with orthopedic billing modifiers to ensure payment from payers.
Pre- and Post-op Billing Challenges
No doubt, global periods offer many benefits, but orthopedic surgery practices also face challenges.
Usually, orthopedic billers struggle with pre- and post-op billing because global period rules make it difficult to separate all service charges.
Some common challenges include:
- Staff may be unsure which visits are included in the global package.
- Rejections of claims that don’t meet CMS orthopedic billing guidelines.
- Mistakes when multiple procedures with different global periods occur.
To solve these challenges, you should:
- Apply orthopedic surgery global period rules correctly.
- Use accurate codes and modifiers for extra services.
- Hire a professional billing company to handle these complexities efficiently.
Bundled Services in Orthopedic Billing
Global periods require providers to think in terms of bundled services. In this model, healthcare providers charge once for a group of services instead of billing for each task individually.
This bundling directly affects orthopedic revenue. For instance, if a surgeon bills for a service already covered under a global package, CMS or another payer can reject the claim. Conversely, if the practice fails to bill separately for services not included, revenue is lost.
These issues can be avoided through correct coding and precise documentation.
CMS Guidelines and Orthopedic Global Periods
CMS is the main regulator for global period policies. The surgical global package rules from CMS apply to Medicare claims and also influence private payers.
CMS defines that:
- The package includes pre-op visits, the surgery itself, and routine post-op care.
- Providers can bill separately for services that are not related to the surgery.
- A specific number of days is assigned for each global period.
These guidelines are mandatory. Hospitals that fail to follow CMS guidelines face compliance risks and revenue loss.
How SysMD Helps Orthopedic Practices
Managing orthopedic surgery global periods is not easy. Many practices lose revenue due to coding errors or claim denials. This is where a trusted partner like SysMD makes a difference.
SysMD is a top-tier medical billing company specializing in orthopedic billing and global period compliance. Their team ensures:
- Correct application of surgical package rules.
- Accurate handling of bundled services.
- Clean and compliant claim submissions.
- Maximum reimbursements with fewer denials.
With SysMD, you can focus on patient care while they manage billing complexities.
Conclusion
In conclusion, orthopedic surgery global periods shape how practices bill, how claims are submitted, and how payments are received. By understanding surgical packages, bundled services, and CMS rules, practices can stay compliant and protect revenue.
For many orthopedic clinics, hiring experts like SysMD ensures smooth billing operations. With the right support, providers can focus on healing patients while staying confident that their billing is accurate and compliant.
FAQs
What is included in an orthopedic surgery global period?
It includes pre-op visits, the surgery itself, and routine post-op visits within the set period.
Can surgeons bill for complications during the global period?
Yes, but only if the complication requires a return to the operating room. Routine complications are included in the package.
How do modifiers help in global period billing?
Modifiers like 24 and 79 identify services not related to the surgery, allowing separate billing.
Do all orthopedic procedures have the same global period?
No. CMS assigns 0-, 10-, or 90-day global periods depending on the procedure.
Why is documentation important in orthopedic billing?
Clear documentation shows whether a service is related or unrelated to the surgery. It supports correct claims submission and prevents denials.