On January 2nd, 2020, John Smith is at home when he experiences a heart attack.  Thankfully, John has excellent health insurance benefits with ABC Insurance, so when his doctor, Dr. Smith, tells him that he needs to have open heart surgery, he has one less concern going into it.  John's surgery was a success, and after a week, he is discharged to go home and undergo his recovery. John is given an appointment card to see Dr. Smith to have the surgical wound examined, and in a week, John can have the staples removed from his chest and down both of his legs.

When John returns for his follow-up appointment, he is handed a medical bill for a 99245 office visit. During this appointment, Dr. Smith is wearing green surgical scrubs, looks at John's staples, and says that his surgery is healing fine. His visit with Dr. Smith takes less than 30 seconds when John is given another appointment card for the staples to be removed.  The appointment is for a home health nurse (who has never treated John) to come to his home and remove the staples.  The nurse does so with an everyday staple remover from the local office supply store. Afterward, John receives another bill in the mail. This bill is also for a 99245 consultation from Dr. Smith.  With another appointment card from the home health nurse, John goes back to see Dr. Smith again, but this time, Dr. Smith isn't wearing surgical scrubs, instead he is wearing a black suit.  Dr. Smith tells John that his post-surgical healing is progressing well.  John is handed another appointment card to see Dr. Smith, as well as a third medical bill, another 99245 consultation.  As in the TV shows, the stories are real, John Smith is a real person, but his name is changed to protect his innocence.  

When John had his open heart surgery, what Dr. Smith didn't know is that when he billed John for a consultation, the bill was wrong.  The visit should have cost John nothing, and the reason for this is because the surgery falls into what is called the Global Surgery Period, also known as the Global Surgical Package.  

The Global Surgical Package includes all the necessary services normally furnished by a surgeon before, during, and after a procedure.  Under the Global Surgical Package, there is a 0-day post-operative period.  Under the 0-day period, a visit on that day is not payable to the doctor, so he cannot bill the patient for this. For some surgeries/procedures, there is a 10-day post-operative period.  Under the 10-day post-operative period, the total period is 11 total days (the actual day of surgery is counted plus 10 days immediately following the surgery).  For other procedures/surgeries, there is a 90-day post-operative period with the total global period being 92 days (count one day before the day of the surgery, the day of surgery, and the 90 days immediately following the day of surgery). 

John's open-heart surgery is deemed to have a 90-day period, which means that Dr. Smith cannot charge John for the office visits within 90 days following the surgery. Under the global surgery package, follow up visits are included, and therefore, not payable separately.  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 are also not payable.  

So, the charges for all the consultations surrounding the date of surgery plus 90 days are not payable and any payments (outside of any co-payments/co-insurances/deductibles) made by John are to be returned to him. 

When I had my open heart surgery, the surgeon tried to charge me for all of his 99215 office visits that were included in the global surgery period.  All of his bills were disputed, and his payments were denied and refunded to me and I never went back to see him again.  About a year later, I unfortunately began having chest pains again and my primary care provider sent me to a cardiology practice where the cardiologist was the same doctor who had billed me for the office visits during the global period (he was now dismissed from the practice), so I ended up in a new practice with a brand new doctor.  To give this a happy ending, both the original surgeon and I terminated our patient-provider relationship, which is a story for another article to be published at a later time.  

Steve Verno