We are having an issue with a patient. He is stating that he has been told by Medicare that his dad can have a second surgery only 60 days after the first procedure (same body part – opposite side).

However, my very experienced biller (30 years) is having difficulty making him understand the concept of the 90-day global period and the fact that if we do surgery prior to that time on a second body part, we most likely won’t get paid for the surgery.

So, if a Medicare patient has a surgical procedure with a 90-day global period, when is the earliest that patient can have another procedure by the same surgeon? EG: Patient has a LEFT total knee on 1/1/17. Is the EARLIEST he can have the RIGHT total knee at any date after April 3rd (92 days total as listed in the CMS global period)? Is my biller missing something?

Any references you can point us to would be helpful as the patient states he has two sources that are telling him 60 days – one at the national office and one at the local office. HELP!

Julie V.
TJRC