During the global surgical period for a major procedure performed by the same surgeon, the patient returns to the clinic for routine postoperative wound checks related to that surgery. How are those E/M services generally treated for professional billing?

Under CMS global surgery rules for a major procedure, routine postoperative evaluation and management related to that surgery is packaged into the global surgical payment for the global period. When the same surgeon (and, in many payment contexts, same-group practitioners) sees the patient in a civic clinic for routine wound checks related to the operation, those E/M services are generally not separately billed. Separately identifiable or unrelated E/M during the global period may be considered only when documentation meets exception criteria and an appropriate modifier (such as 24 for unrelated E/M) is supported. Always billing a high-level office E/M with modifier 24 for every postop check fails because 24 requires an unrelated E/M, not routine surgical aftercare. Converting each postop visit into a new surgical CPT to restart the global fails by fabricating procedural services and abusing global-period logic. Billing the visits as consultations because another physician’s staff room was used fails by misusing consultation constructs and ignoring global package bundling. Exam caveat: NCCI interacts with but does not replace global package rules; analyze both when same-day or postop E/M questions appear on CCS-P. Operational check: confirm major-procedure global days and DOS within the global window, read whether the visit is routine related aftercare versus unrelated problem, omit routine related E/M, and attach modifier 24 only with clear unrelated documentation in the municipal surgical clinic record.