Numerous reimbursement rules apply to claims for such surgery, depending on which procedure is performed, where it is performed, and when it is performed. Understanding these rules ensures cleaner claims and proper payment for services provided. In 1992, Medicare instituted a global surgery policy as part of physician payment reform. Under this policy, a single fee is paid for all necessary services normally furnished by the surgeon before, during, and after the procedure. Before this change, each carrier paid for surgery in a unique way.
Different rules apply to the reimbursement for each type of surgery.
Because both major and minor surgeries may be performed in-office, I will define each type of surgery and describe the types of reimbursement rules that apply. Major Surgery Major surgeries are defined as those that have 90-day postoperative periods. Major surgeries are divided into preoperative, intraoperative, and postoperative periods. For ophthalmic procedures, the preoperative portion is the day before surgery. The intraoperative portion is the surgery itself.