What is the Global Surgical Package? Everything Beginners Must Know

The global surgical package is a payment and coding concept that bundles the surgical procedure with specific pre-operative and post-operative services into a single reimbursement. When a surgeon performs a procedure that carries a global period, many of the related services before and after the surgery are included in the procedure’s payment — they are not billed separately. Understanding what is included in the global package and what can be reported separately is essential for the CPC exam and for accurate surgical coding in practice.

This concept directly impacts how you assign CPT codes for surgical encounters. If you do not understand the global surgical package, you will either overcode by reporting services that are already included, or undercode by failing to report services that are separately billable. Both types of errors appear as answer choices on the CPC exam. For background on how surgical CPT codes are organized, see Surgery Coding for Beginners.

What Is the Global Surgical Package?

The global surgical package — also called the global period or global days — defines a window of time around a surgical procedure during which all normal pre-operative and post-operative care is considered part of the procedure. Medicare and most commercial payers use this system to bundle related services into one payment rather than paying separately for every pre-op visit, the surgery itself, and each follow-up visit.

Every CPT surgical procedure code is assigned one of three global period designations:

The designation for each CPT code can be found in the Medicare Physician Fee Schedule (MPFS) database. The CPC exam does not require you to memorize which codes have which global periods, but you must understand what each period means and how it affects coding.

What Is Included in the Global Surgical Package

The global surgical package includes specific services that cannot be billed separately during the global period. Understanding exactly what is bundled is the key to answering CPC exam questions on this topic.

Pre-Operative Services Included

For major surgeries with a 90-day global period, the pre-operative visit on the day before and the day of surgery is included. This covers the pre-operative evaluation, history and physical examination, and any routine pre-operative care related to the decision to perform surgery.

For minor procedures with a 0-day or 10-day global period, only the pre-operative services on the day of the procedure are included.

Important distinction: The initial evaluation and management (E/M) visit during which the decision for surgery is made is NOT included in the global package and IS separately reportable. This is a frequently tested point. The decision for surgery visit is reported with modifier 57 (Decision for Surgery) appended to the E/M code.

Intra-Operative Services Included

Everything that happens during the surgical procedure is included in the procedure code. This covers the operation itself and all normal intra-operative services such as local anesthesia or topical anesthesia administered by the surgeon, one instance of a related surgical procedure performed at the same session (unless a separate procedure code exists), and routine closure of the surgical site including simple wound repair.

Post-Operative Services Included

Post-operative follow-up visits during the global period are included in the surgical package when they relate to recovery from the procedure. This includes routine post-operative visits (suture removal, wound checks, drain management), post-operative pain management by the surgeon, and management of complications that do not require a return to the operating room.

What Is NOT Included — Separately Reportable Services

Several categories of services are specifically excluded from the global surgical package and can be reported separately. This is where CPC exam questions focus most heavily.

The Decision for Surgery Visit

When the surgeon evaluates the patient and decides that surgery is necessary, this E/M visit is reported separately with modifier 57 appended. Modifier 57 tells the payer that the E/M service was the encounter during which the decision to perform the major surgery was made.

Example: A patient presents to the surgeon’s office with acute abdominal pain. The surgeon evaluates the patient, reviews imaging, and determines that an appendectomy is necessary. The surgeon performs the appendectomy the next day. The office visit where the decision was made is separately reportable with modifier 57 on the E/M code.

For minor procedures with a 0-day or 10-day global period, some payers accept modifier 25 (Significant, Separately Identifiable E/M Service) instead of modifier 57 for the decision visit.

Unrelated E/M Services During the Global Period

If the surgeon sees the patient during the post-operative global period for a reason unrelated to the surgery, that E/M visit is separately reportable with modifier 24 (Unrelated E/M Service by the Same Physician During a Postoperative Period).

Example: A surgeon performs a knee replacement (90-day global period). Three weeks later, the same patient returns to the surgeon with a new complaint of shoulder pain unrelated to the knee surgery. The E/M visit for shoulder pain is reported with modifier 24.

Return to the Operating Room for Complications

If the patient must return to the operating room for treatment of a complication during the global period, the procedure performed to treat the complication is separately reportable with modifier 78 (Unplanned Return to the Operating/Procedure Room by the Same Physician Following Initial Procedure for a Related Procedure During the Postoperative Period).

Example: A patient who had bowel surgery develops a post-operative wound dehiscence requiring surgical repair in the OR. The repair procedure is reported with modifier 78.

Unrelated Procedures During the Global Period

If the surgeon performs a procedure during the global period that is unrelated to the original surgery, it is separately reportable with modifier 79 (Unrelated Procedure or Service by the Same Physician During the Postoperative Period).

Example: A surgeon performs a cholecystectomy (90-day global period). Six weeks later, the same patient needs a carpal tunnel release by the same surgeon. The carpal tunnel release is reported with modifier 79.

Staged or Related Procedures

When a subsequent procedure was planned at the time of the original surgery (a staged procedure), it is reported with modifier 58 (Staged or Related Procedure or Service by the Same Physician During the Postoperative Period). Modifier 58 starts a new global period from the date of the subsequent procedure.

Key Modifiers for Global Period Scenarios

How Global Period Days Are Counted

The counting method is specific and the CPC exam tests it:

Day 0 is the day of the procedure. Pre-operative services on this day are included in the global package.

Day 1 is the day after the procedure. The post-operative global period begins counting on Day 1.

For a 10-day global period: The global period covers Day 0 (procedure day) through Day 10 post-op. Any routine follow-up during these 10 days is included.

For a 90-day global period: The global period covers Day -1 (the day before surgery for pre-op), Day 0 (procedure day), through Day 90 post-op. Any routine follow-up related to the surgery during these 90 days is included.

Example: If a major surgery with a 90-day global period is performed on March 1, the global period runs through May 29 (March has 31 days remaining from March 2, plus April 30, plus May 29 = 90 days). A routine follow-up visit on May 20 is included. A routine follow-up on May 30 is outside the global period and can be billed separately.

How the CPC Exam Tests the Global Surgical Package

Pattern 1 — Identifying Separately Reportable Services

The question presents a surgical scenario with additional services (pre-op visit, post-op complication, unrelated visit during global period) and asks what can be reported separately. You must know which services are bundled and which are excluded from the package.

Pattern 2 — Modifier Selection

The question describes a service performed during the global period and asks which modifier makes the service separately reportable. The answer depends on whether the service is an E/M visit or a procedure, whether it is related or unrelated to the original surgery, and whether a return to the OR was involved.

Pattern 3 — Decision for Surgery

The question describes an E/M encounter where the surgeon decides to perform surgery. You must recognize that this visit is separately reportable and know whether to append modifier 57 (major surgery) or modifier 25 (minor procedure on the same day).

Pattern 4 — What Is Included

The question asks which of several listed services is included in the global surgical package and therefore should NOT be billed separately. Common included services that trip up test-takers: routine post-op visits, simple wound closure, local anesthesia by the surgeon, and uncomplicated post-operative pain management.

Common Mistakes

Billing routine post-op visits separately. If a follow-up visit is within the global period and relates to recovery from the surgery, it is included in the surgical package. Reporting it as a separate E/M is overcoding.

Using the wrong modifier for complications. Modifier 78 is for unplanned return to the operating room for a complication. If the patient is seen in the office for a complication (not in the OR), that office visit is part of the global package and is not separately reportable. The distinction is whether the patient returns to the OR.

Forgetting that modifier 58 resets the global period. When a staged procedure is performed with modifier 58, a new global period begins from the date of the staged procedure. Some coders track the original global period but miss that the staged procedure starts its own.

Confusing modifiers 24 and 79. Modifier 24 is for an unrelated E/M service. Modifier 79 is for an unrelated procedure. Both deal with “unrelated” services during the global period, but they apply to different service types. See the CPT Modifiers Guide for the complete modifier reference.

Not appending modifier 57 to the decision for surgery visit. The E/M visit where the surgeon decides to perform major surgery is separately reportable — but only when modifier 57 is appended. Without the modifier, the payer will deny the E/M as part of the global package.

Frequently Asked Questions