Fees, Global Surgical

The American Academy of Family Physicians (AAFP) believes the global period for all surgical services should be zero days. All surgical services with a longer global period, such as 10 or 90 days, should have their global period reduced to zero days and be revalued accordingly. Use of a zero-day global period facilitates more accurate valuation of surgical services, because it removes the need to standardize the number and level of post-operative visits, which are often highly variable.

The AAFP defines a global surgical fee as payment to the primary operating physician for all surgically-related services rendered to the patient for that specific condition from the date of an operation through a specified number of days following surgery. Consistent with Current Procedural Terminology, the following services related to the surgery when furnished by the physician who performs the surgery should be included in addition to the operation per se:

• Evaluation and Management (E/M) service(s) after the decision for surgery on the day before and/or day of surgery (including history and physical)
• Local anesthesia services
• Immediate postoperative care, including dictating operative notes, talking with the family and other physicians or other qualified health care professionals
• Writing orders
• Evaluating the patient in the post-anesthesia recovery area
• Typical postoperative follow-up care within the specified length of the global period, including related telephone calls and patient communications

Global surgical fees should not include care for post-operative complications except those frequently associated with the specific surgical procedure. When medically indicated, additional payment to an assisting physician should be made for the intraoperative portion of such care. Also, pre-operative evaluations provided by family physicians not performing the procedure should be paid separately outside the global surgical fee. (1984) (April 2024 BOD)