Subsection 351-5-2-04 - SURGICAL GUIDELINES1. For surgical procedures that usually mandate a variety of attendant services, the reimbursement allowances are based on a global reimbursement concept. Global reimbursement covers the performance of the basic service and the normal range of care required before and after surgery. The normal range of postsurgical care is indicated under "Global Days" in Appendix II. The maximum allowable payment for a surgical procedure includes all of the following:A. Any visit that has as its principal function the determination that the surgical procedure is needed.B. All visits which occur after the need for surgery is determined and are related to or preparatory to the surgery.D. All post-surgical care services, which are routinely performed by the surgeon or by members of the same group within the same specialty as the surgeon, including removal of sutures.2. The following four exceptions to the global reimbursement policy may warrant additional reimbursement for services provided before surgery:A. When a preoperative visit is the initial visit and prolonged detention or evaluation is necessary to prepare the patient or to establish the need for a particular type of surgery.B. When the preoperative visit is a consultation.C. When preoperative services are provided that are usually not part of the preparation for a particular surgical procedure. For example, bronchoscopy prior to chest surgery.D. When a procedure would normally be performed in the office, but circumstances mandate hospitalization.3. Additional charges and reimbursement may be warranted for additional services rendered to treat complications, exacerbation, recurrence, or other diseases and injuries. Under such circumstances, additional reimbursement may be requested.4. An incidental surgery will not be paid under the Workers' Compensation system.5. When two or more surgical procedures are performed at the same session by the same individual, the highest weighted surgical code is paid at 100% of the fee listed in Appendix II and additional surgical procedures are paid at 50% of the fee listed in Appendix II. Add-on codes are not subject to discounting. C.M.R. 90, 351, ch. 5, § 351-5-2, subsec. 351-5-2-04