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Skin procedures done in office for pre-malignant lesions and global ?

Chris Posted Fri 19th of July, 2019 10:40:19 AM
When a 58 or 79 modifier is applied and it restarts the global period. does that mean anything done to the original procedure is no longer in a global? Example. Patient has multiple pre malignant lesions, too many to treat in one session. The first treatment is 15781 dermabrasion face for rosacea on 05/15/2019. This has a 90 day global. the patient returns on 06/01/2019 for 17108 destruction of cutaneous vascular lesions (sub q hemangiomas on the trunk) this also has a global period of 90 days. and is 'unrelated' to the rosacea so we used -79 modifier. The next visit 06/15/2019 the doctor does a botox injection for Chronic migraine (79 mod unrelated or 17108). during this visit the doctor also says the 05/15 rosacea treatment is doing well and he changes a prescription cream for the rosacea. He wants to bill an office visit same day as the botox because the 'perscription' for the rosacea is above and beyond the botox injection. If the global period for the Rosacea did 'restart' with a new global period when the hemangiomas were treated, then can this E&M be billed? normally I would say no because it's a 'follow-up' during a global period. Very confused about what it means when the global period resets. Please clarify.
SuperCoder Answered Mon 22nd of July, 2019 04:25:56 AM

Hi Chris,


E&M service would not be a billable service since the E&M visit has been performed for Rosea which is within the global period of CPT code 15781. Though the visit is unrelated to Botox procedure but cannot be billed since it is within the global period of the original procedure performed on 05/15. Had the global day period of this code passed the time lines of 90 days, we could have billed an established visit E&M code for an unrelated E&M visit performed for Roscea along with Botox injection.


Hope, provided information would be helpful.



Chris Posted Tue 23rd of July, 2019 11:24:43 AM
This didn't really answer my question. I just need to know, when a global period resets because another 90 day procedure is being done (as an example 14 days after another procedure that had a 90 day global period)… The procedures are 'unrelated' but the global period restarts. Does the original global period completely end?
Chris Posted Tue 23rd of July, 2019 16:29:52 PM
Here's an example:Patient has a total right hip arthroplasty on 3/20/20XX. The same surgeon performs a left rotator cuff repair on 6/15/20XX • Surgery 1 27130 • Surgery 2 29827-79 . Surgery 2 with the -79 "restarts" the global period. But is that just a 'restart' for the 2nd surgery? Is the first surgery still in it's 90 day global? Or did that global period stop when the new unrelated procedure began?
SuperCoder Answered Wed 24th of July, 2019 04:30:19 AM

Hi Chris,


Global period does not change. Global period of a code is specific to that code. In your case, CPT code 15781 has a global period of 90 days and will remain so for 90-day period post the procedure date. Any E&M visit provided during these visits for the concerned problem will be considered inclusive service and will not be paid separately. Any other major procedure (with global period of 90 days) performed within the global period of CPT code 15781 will not reset the global period since both are different procedures and will have their different global period from the post - op day 1 of the surgery. Global periods do not have effect of each other.


Hope provided information would be helpful.




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