Globally Inclusive to Surgery/Globally Inclusive

Denial Info & Occurrence:

• Any surgery has 3 different time periods: Pre-operative, Intra-operative & Post-operative.
• Pre-operative Period: This period occurs prior to the surgery where the provider gathers all the relevant information to make sure there is no obstacle when performing the surgery.
• Intra-operative Period: This is a period where actual surgery is performed.
• Post-operative Period: This period occurs after the surgery where the provider monitors the patient on a timely basis to make sure that the patient is safe & comfortable.
• Post-operative period is considered as a Global period and it starts from the date when the surgery is performed. During this period if the provider performs any other surgery/service related to the main surgery then it will not get paid and will be considered as globally inclusive to main surgery.
• If the other surgery/service is performed during the post-operative period and is not related to the main surgery then it needs to be billed with the appropriate modifier or else this denial will occur.
• To determine whether a service is related to the main surgery or not and to get the appropriate modifier, the claim must be assigned to the coding team.

On Call Scenario:

                                         Claim denied as Globally inclusive to Surgery
                                                                         ↓
                                                       May I get the denial date?
                                                                         ↓
                                             When was the main surgery performed?
                                                                         ↓
                                                      What is the Global period?
                                                                         ↓
                          Find out the Global period range, starting from main surgery
                           date and calculate end date by adding global period time to
                           main surgery date. Check if the DOS lies between the range
                                       ↙                                                                    ↘
                                  Yes                                                                       No
                                    ↓                                                                          ↓
                  What is the time limit to                               Could you please send the claim
                    send corrected claim?                                back for reprocessing as the DOS

                                    ↓                                                  lies outside of the global period?

               What is the Fax# or Mailing                                                    ↓

                address to send an appeal?                            What is the TAT for reprocessing?

                                    ↓                                                                          ↓

                How much is the time limit                           May I get the Claim# & Call ref#?

                      to send an appeal?

                                    ↓

                    May I have the claim#

                           & call ref#?

Important Notes & Actions:

• Please take action as per your process update. Below actions can be different from your process update.
• If the claim is denied for globally inclusive to surgery and the service lies between the global period range then it should be sent to the coding team for the appropriate modifier.
• If the coding team provides an appropriate modifier then update it and resubmit a corrected claim.
• If the coding team states that there is no appropriate or alternative modifier then you can either send an appeal or write off the claim. So work as per your client's instructions.
• If the claim is denied for globally inclusive to surgery and the service does not lie between the global period range and the rep agrees to reprocess the claim then set the follow-up of the TAT provided by the rep.

Prepare Notes:

Source of Status:

* Call Website EOB System

Clearing House Comment (Please make the changes if required):

Insurance Name:

*

Clearing House Name:

Insurance Phone#:

*

Rep Name:

*

Website Name:

*

Denial Date:

*

Is main surgery performed date available?:

* Yes No

Main Surgery Date:

*

Global Period:

*

Is DOS lies within the waiting period:

* Yes No NA

TAT for Reprocessing:

*

What Information is Available?:

* Corrected Claim Time Frame Appeal Information Corrected Claim Time Frame and Appeal Information None

Corrected Claim Time Frame:

*

Mode of appeal:

* Fax Mail Website

Fax Number:

*

Website Link:

*

Mailing Address:

*

Appeal Limit:

*

Additional Comment:

Claim Number:

*

Call Reference#

*

Action:

* Need coding assistance Updated correct modifier and resubmitted the claim Updated correct CPT and resubmitted the claim Updated correct DX and resubmitted the claim Adjust off the claim Need client assistance Need to send an appeal Need to allow time Appeal Sent



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