Surgical package

When Medicare—and most commercial payers—pay for a surgical procedure, that payment covers far more than the operation itself. The global surgical package wraps together: the pre-operative visit on the day before or day of surgery (after the decision to operate has already been made), all intra-operative services that are a standard part of that procedure, immediate post-anesthesia recovery care, operative note dictation, post-surgical pain management, routine wound care (dressing changes, staple and suture removal), and all follow-up office visits that fall within the assigned global period. Under Medicare, every procedure code in the Physician Fee Schedule carries a global surgery indicator—000 (zero post-op days), 010 (ten post-op days), or 090 (ninety post-op days)—that defines exactly how long the bundle extends after the date of surgery.

For orthopedic procedures, the 090-day package is the norm for major open and arthroscopic surgeries. That means a total knee arthroplasty (CPT 27447), a rotator cuff repair (CPT 29827), or an ORIF of a distal radius fracture (CPT 25600–25609) all carry a 90-day global window. Any E/M visit, injection for pain management, wound check, or minor procedure provided by the operating surgeon—or by a same-specialty provider in the same group—within that 90-day window is considered bundled and cannot be billed separately unless a specific exception applies. Fracture care codes have their own global period rules and also bundle casting, splinting, and strapping services performed at the same encounter.

The CPT surgical package definition differs slightly from the Medicare global surgery definition. CPT bundles local infiltration, digital block, topical anesthesia, and typical post-operative follow-up into the base procedure code. Medicare layers on top of that a specific calendar-based post-operative period and additional bundled services tracked through NCCI edits. Coders working in orthopedic practices must be fluent in both frameworks because payer mix determines which set of rules governs any given claim.

Misunderstanding the surgical package is one of the highest-risk unbundling exposures in orthopedic practice. Billing a separate E/M visit for a routine wound check within a 90-day global period—or billing CPT 12001–13153 wound repair codes to describe closure of a surgical incision—will trigger NCCI prepayment edits and denial. Systematic unbundling can escalate to a RAC or OIG audit, demand letters for overpayments, and potential False Claims Act liability. Conversely, failing to bill separately for services that genuinely fall outside the package (e.g., an unrelated E/M visit with modifier 24, a new injury treated during the global period with modifier 79, or a return to the OR for a complication with modifier 78) leaves legitimate revenue on the table.