You perform a bunion surgery that goes perfectly, and the patient is healing well. Six days later, the patient returns for a follow-up. During the visit, you find a new diabetic ulcer on the other foot. It needs quick evaluation and treatment. Spend 30 minutes on this separate condition. Document everything well. Then, submit the claim.

Two weeks later: The claim gets DENIED. “Service included in global surgical package.”

Sound familiar? Global period denials are the silent revenue killer lurking in every podiatry practice that performs surgery. Even when you’ve done everything according to the process, used the correct modifier, and documented thoroughly but payers still deny these claims.

The fact is, thousands of dollars in legitimately earned revenue are walking out of your practice every month simply because global period denials feel too complicated, too time-consuming, or too likely to fail to appeal. But here’s the good news: when approached strategically with the right documentation and persistence, global period appeals have remarkably high success rates.

This guide will transform how you handle global period denials. You’re about to learn a systematic approach that delivers results.

What Is a Global Period in Podiatry

In podiatry, a global period is a timeframe after surgery in which all follow-up visits are presumed to be part of the payment for surgery. This means that visits following surgery may not be covered during this timeframe.

The world periods are different in podiatry, based on the type of operation:

• Minor surgeries (for instance, removal of an ingrown toenail) may have an overall global period of 0-10 days
• For major foot surgery, such as an anatomic correction (bunionectomy) or reconstructive surgery, the global period can be 90 to 180 days.

The insurance companies are able to deny the payment of claims regarding post-operative visits or injections in the event they consider these procedures as falling within the global period.

Common Reasons for Global Period Denials

To develop an appeal that will be successful, understanding the reasons behind a denial has great importance. There are a few common reasons why a denial can occur:

Incorrect coding

This means, a service that has been coded by the provider was cancelled by the insurance company to fall within the comprehensive package.

Unrelated services not involving the surgery: 

A claim may be denied simply because the visit was also for something new that is not connected with the initial procedure.

Administrative Issues

Administrative errors, including inaccuracies in patient information, insurance, and date of service, are potential denials.

Insufficient documentation

If a lack of documentation exists regarding why the service was medically necessary outside the global period, then the insurance provider can deny a claim.

Steps to Appeal Global Period Denials

Appealing the denial of the global period needs to be done in an organized and documented manner. Here’s a step-by-step process for a global period denial appeal:

Examine the Notice of Denial

Firstly, it is important to review the denial of insurance benefits letter. To begin with, one needs

• Denial code
• Date of service and global period end date
• Reason for denial

For application form standards, follow the guidelines provided by the U.S. Federal healthcare website.

Validate Coding Accuracy

Make sure your CPT codes reported are correct. Inaccurate codes applied often result in claims being denied.

Determine if the current procedure is considered major or minor from a worldwide perspective. Look up whether the service needs to be coded with a modifier, like -24, which means “unrelated evaluation and management service during global period”.

Assemble Documentation

Documentation is your greatest asset during the appeal process. Gather:

• Patient record entries
• Surgical records
• Progress notes indicating the reason for the visit
• Results of any lab or imaging studies that establish medical necessity

The intent is to prove that the medical procedure was necessary and had no connection to the world period surgery.

Use the Right Modifiers

Modifiers are either makers or breakers of claims. For podiatry, global period exceptions are modified using modifier number 24.

Modifier -24 suggests that there is no relation between the service and the primary procedure.

Explain in your documents that your visit or service has nothing to do with any surgical procedure. The use of erroneous or missing modifiers generally causes denials that can be prevented.

Submission of Appeal on Appeal Deadline

The insurance firms may have a deadline to submit appeals.

• Check the appeal deadline from the insurer
• Through the preferred method (website portal, mail, or fax)
• Make sure that you retain all your documents

Follow Up Regularly

After submission, monitor the appeal status, follow up with the insurance company periodically, and maintain good records of communication. Sometimes it’s helpful to be persistent in following up because claims get lost or are overlooked.

Conclusion

Global period denials are not an unusual experience for podiatric clinics. With the right documentation, coding, and communication, a significant number of global period denials can be successfully appealed. If clinics put more emphasis on training staff, documenting, and explaining global period concepts to patients, the possibility of denials will decrease, and the rapport with patients as well as with insurance companies will also improve.

In some cases, it may take some work to appeal an insurance denial, but you will be rewarded for it in terms of protecting your practice and your patients’ access to appropriate foot care.

If your practice needs assistance with podiatry billing services, working with us can help reduce claim rejections. Contact us to learn how our services can support your clinic’s operational and revenue goals.

FAQs

How do I know if a denial is appealable?

Appealable denials include those for “services included in global period” when modifiers were used correctly, but documentation lacks linkage to a new/unrelated condition, complication, or staged plan.

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What documentation is critical for modifier -79 (unrelated procedure)?

Include operative reports from both procedures showing distinct anatomic sites or pathologies, post-op notes tracking the clinical course, and diagnoses proving no relation to the index surgery.​

How long do I have to appeal a global period denial?

Most payers require appeals within 30-180 days from the EOB date; Medicare allows 120 days, while commercial plans like Aetna or United often specify 60-90 days—always check the EOB or payer portal for exact timelines.​

Can I bill E/M visits during the 90-day global without modifiers?

No, routine post-op E/M is bundled and non-billable; only bill with modifiers like -24 for unrelated issues, supported by notes showing a new problem (e.g., contralateral foot pain) and avoiding surgical site overlap.​

What if the payer denies my appeal next steps?

Request a peer-to-peer review with the medical director, escalate to Level 2 appeal with more evidence, or open an external review if state laws allow; track patterns for payer disputes or compliance audits.