Awareness : OBC Tips

Services Not Included in the Global Surgery Fee:

  • The initial consultation or evaluation of the problem by the surgeon to determine the need for surgery.  This service must be billed using modifier code 57.
  • Visits UNRELATED to the diagnosis, for which the surgical procedure is performed, unless the visits occur due to complications of the surgery, these services must be billed with modifier code 24.
  • Services of other physicians, except where the surgeon and other physician(s) agree on the transfer of care.
  • Treatment for the underlying condition or an added course of treatment, which is not part of the normal recovery from surgery.
  • Critical Care services which are UNRELATED to the surgery where a seriously injured or burned patient is critically ill, these services must be billed with modifier code 24.
  • Clearly distinct surgical procedures during the post-operative period, which are not re-operations or treatment of complications.
  • The performance of a more extensive procedure if a less extensive procedure fails.
  • Staged or related procedure or service by the same physician during the post-operative period, these procedures must be billed using modifier code 58.
  • Repeat procedure by the same physician, these procedures must be billed using modifier code 76.
  • Repeat procedure by another physician, these procedures must be billed using modifier code 77.
  • Treatment for post-operative complications, which requires a return trip to the operating room, these services must be billed using modifier code 78.
  • Unrelated procedure or service by the same physician during the post-operative period, these procedures must be billed using modifier code 79.
  • Immunosuppressive therapy for organ transplants.
  • Surgical trays furnished in the physician’s office, including splints and casting supplies.
  • Diagnostic tests and procedures, including radiological procedures.