Global Survey Policy and NCCI
Tendo Marketplace’s global surgery payment policy includes all the necessary services normally furnished by a surgeon before, during, and after a procedure. Payment for a surgical procedure includes the preoperative, intra-operative, and post-operative services routinely performed by the performing surgeon.
Providers can define custom definitions for their bundles instead of using the global surgery payment policy, but we discourage it because it makes it harder for patients and care navigators to compare different offers from different providers.
A global period is the post-operative period of time during which routine post-operative care is expected to be included in the global surgery payment. The length of the global period varies depending on the type of surgery performed - 0, 10, or 90 days.
- 0 day Physician fee - Physician supervision and treatment in hospital. Does NOT include the initial evaluation to determine the need for the procedure.
- 10-day Physician fee - Treatment and procedure-related postoperative follow-up visit(s) within 10 days of surgery. Does NOT include the initial evaluation to determine the need of the procedure.
- 90-day Physician fee - Treatment and procedure-related postoperative followup visit(s) within 90 days of surgery. Does NOT include the initial evaluation to determine the need of the procedure.
Services included in the global surgery:
- Pre-operative visits after the decision has been made to move forward with the procedure
- Intra-operative services that are a usual and necessary part of the procedure
- Additional medical or surgical services required of the performing physician during the post-operative period of the surgery because of complications which do not require additional trips to the operating room
- Follow-up visits with the performing physician during the post-operative period of the surgery that relate to recovery from the surgery
- Post-surgical pain management when provided by the performing physician
- Miscellaneous services such as dressing changes, local incision care, removal of operative pack, removal of cutaneous sutures and staples, lines, wires, tubes, drains, casts, and splints; insertion, irrigation, and removal of urinary catheters; routine peripheral intravenous lines; nasogastric and rectal tubes; and changes and removal of tracheostomy tubes
Services NOT included in the global surgery:
- Initial consultation or evaluation of the problem by the physician to determine the need of the procedure
- Services of other physicians related to the surgery (unless included in the bundle)
- Visits unrelated to the diagnosis for which the surgical procedure is performed, unless the visits occur due to complications of the procedure
- Treatment for the underlying condition or an added course of treatment which is not part of the normal recovery of the surgery
- Diagnostic tests and procedures, including diagnostic radiology procedures
- Clearly distinct surgical procedures that occur during the post-operative period which are not re-operations or treatment for complications
NCCI Edits
National Correct Coding Initiatives (NCCI) edits are a set of rules put in place to encourage national guidelines that support correct coding and reduce improper claim payments. The edit is used to identify pairs of CPT®/HCPCS codes that should not be reported together on the same claim because they are considered mutually exclusive or because one code is a component of another code. These are called Procedure to Procedure (PTP) edits.
In the example below, only CPT® code 25447 will be reimbursed if both codes are submitted on the claim for the same date of service. This is because there is an NCCI edit between 25447 and 25210. Therefore, the patient should only purchase the procedure containing CPT® code 25447 (Tendon or Muscle Repair in Forearm or Wrist) as CPT® code 25210 is a component of CPT® code 25447. This is what an NCCI edit looks like when searching both CPT® codes on the Providers portal:
