Global Periods, Modifiers 24/25/57/58/79 & Post-Op Coding
The global surgical package is one of the most misunderstood reimbursement concepts in surgical billing. Surgeons and their billing teams routinely leave money on the table by not billing separately for services that fall outside the global package, and they equally risk audits by billing for services that should be included. A surgical practice that consistently misses modifiers 24, 57, and 78 across a full case load leaves legitimately billable post-op and decision-for-surgery visits unclaimed. The modifiers that break open the global package are worth knowing cold.
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A global period is the number of days after surgery when related care is included in the surgeon's single payment. CMS assigns 0, 10 or 90 days to each procedure code. Routine post-op visits in that window aren't billed separately, while unrelated care needs a modifier such as 24 or 79.
When a surgeon bills a surgical procedure code, Medicare and most commercial payers reimburse a single bundled payment, the global surgical package, that includes:
| Global Period | What It Covers | Example Procedures |
|---|---|---|
| 0-Day Global | Day of surgery only. No post-op visits included. | Minor skin procedures, simple biopsies, injections, endoscopies |
| 10-Day Global | Day of surgery plus 10 days post-op. All related visits included. | Excisions, abscess drainage, minor orthopedic procedures, skin flaps |
| 90-Day Global | Day before surgery through 90 days post-op. Pre-op day 1 visit + all related post-op visits included. | Major joint replacement, spinal fusion, open cardiac surgery, hernia repair, major abdominal procedures |
| XXX (no global) | No global period applies. Each service billed independently. | Radiology, most lab, pathology services |
| ZZZ (add-on codes) | Add-on codes: global period governed by primary procedure. | Add-on CPT codes only |
For a 10-day global, count the day of surgery plus the 10 days after it. A 90-day global also covers the day before surgery and the 90 days after surgery. For a 90-day procedure on March 3, the post-op period ends June 1. Look up each code's global days in the CMS fee schedule.
| CPT | Procedure | Global days (CMS 2026) |
|---|---|---|
| 11102 | Skin biopsy, tangential | 000 |
| 45378 | Diagnostic colonoscopy | 000 |
| 10060 | Drainage of simple abscess | 010 |
| 17000 | Destruction of premalignant lesion | 010 |
| 29881 | Knee arthroscopy with meniscectomy | 090 |
| 47562 | Laparoscopic cholecystectomy | 090 |
| 49505 | Inguinal hernia repair | 090 |
| 27447 | Total knee arthroplasty | 090 |
| 59400 | Obstetric care package | MMM (maternity) |
These modifiers are critical for surgical practices. They signal to payers that a service being billed during or around a global period is not included in the global package and should be paid separately.
Used to bill an E/M visit during the global period for a condition completely unrelated to the surgical procedure. The documentation must clearly establish a different diagnosis and reason for the visit.
Example: Patient is 30 days into a 90-day global period following knee replacement. They present for evaluation of a new shoulder injury from a fall. Bill the E/M with modifier 24.
Appended to an E/M code billed on the same day as a minor procedure (0-day or 10-day global). The E/M must be significant and separately identifiable, beyond the pre-service evaluation included in the procedure.
Example: Patient presents for removal of a skin lesion (10-day global). During the same visit, the physician conducts a complete evaluation of a new hypertension diagnosis. The E/M gets modifier 25.
Audit flag: Modifier 25 is one of the most OIG-scrutinized modifiers. Documentation must support that the E/M was truly distinct, not just a pre-procedure check. A separate chief complaint, history, and distinct medical decision making must be documented.
Appended to the E/M code when the physician makes the decision to perform a major surgery (90-day global) on the same day as the E/M or the day before. Without modifier 57, the E/M for a 90-day procedure would be bundled into the global package.
Example: Patient presents to orthopedic surgeon with acute hip fracture. Surgeon decides on same-day total hip replacement. The E/M gets modifier 57. The surgery gets its own code. At a typical 99215-level payment of $180 to $220, a surgical group doing 15 same-day major-decision visits a month is leaving $2,700 to $3,300 a month unbilled if modifier 57 isn't applied consistently.
Used when a subsequent procedure during the global period was: (a) planned or anticipated at the time of the original procedure, (b) more extensive than the original procedure, or (c) for therapy following a diagnostic surgical procedure. This is distinct from modifier 79; modifier 58 services are related to the original procedure.
Used when performing a surgical procedure during the global period that's completely unrelated to the original procedure. A new global period begins for the new procedure.
| Modifier | Service Type | Relationship to Original Procedure |
|---|---|---|
| 24 | E/M visit | Unrelated: different diagnosis |
| 25 | E/M visit | Same day as minor procedure, separately identifiable |
| 57 | E/M visit | Decision for major (90-day) surgery |
| 58 | Surgical procedure | Staged/related: planned or more extensive |
| 78 | Surgical procedure | Unplanned return to the OR for a complication; intraoperative payment only; no new global period |
| 79 | Surgical procedure | Unrelated: completely different condition |
These services can be billed separately even within the global period:
Global surgery reviews look for two opposite problems. One is billing an E/M during the global period for care that's part of the package, which is unbundling. The other is billing the full global package when a different practice provided the post-operative care, which is why split-care modifiers 54 and 55 exist. Reviewers compare the surgeon's claims to the follow-up visits actually documented.
Modifiers 24, 25, 57, 58, 78, and 79 are the tools that open the package, so they're also the modifiers reviewers test. Each one needs a note that shows why the service was outside the package: unrelated condition, decision for surgery, staged procedure, return to the operating room, or unrelated procedure. Contractors can go back three years, and on a surgical practice with a recurring pattern of unsupported modifier 25 or 57 use, a 3-year lookback with even a modest error rate can put a large recoupment at risk, plus the cost of the appeal.
Global surgery payment is a package. A knee arthroscopy with meniscectomy (29881) pays $515.71 at the 2026 national rate, and that payment includes the usual postoperative care. Two kinds of errors follow. The first is billing a routine post-op visit separately, which Medicare treats as an overpayment. The second is failing to bill an unrelated E/M with the right modifier. A low-level visit (99213) pays $95.19, so 30 unrelated visits a month that go unbilled leave $2,855.70 behind, or $34,268 a year.
Both errors are fixed the same way. Tag every encounter inside a global period by surgery date and require a reason code before a charge is created.
A global period is the number of days after surgery when related care is included in the surgeon's single payment. CMS assigns 0, 10 or 90 days to each procedure code. Routine post-op visits in that window aren't billed separately, while unrelated care needs a modifier such as 24 or 79.
For a 10-day global, count the day of surgery plus the 10 days after it. A 90-day global also covers the day before surgery and the 90 days after surgery. For a 90-day procedure on March 3, the post-op period ends June 1. Look up each code's global days in the CMS fee schedule.
No. Modifier 78 covers an unplanned return to the operating room for a complication, and Medicare pays the intraoperative portion only. It doesn't start a new global period. Modifiers 58 and 79 do start a new post-op period for the new procedure.
The article lists three: a 0-day global covering only the day of surgery, a 10-day global covering the day of surgery plus 10 days after, and a 90-day global that includes the day before surgery and the post-operative period.
When an E/M on the same day as a major surgery results in the decision to operate. The article warns that billing the E/M and a 90-day surgery on the same date without modifier 57 results in an automatic bundling denial.
The article lists treatment of complications requiring a return to the operating room (modifier 78), diagnostic procedures not integral to the surgery, and other services outside the package. Each still needs its own documentation.
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